AMA House of Delegates

AMA meeting: Vitamin D checks urged

Studies associate low levels with increased risk of disease, but more extensive research is needed before testing and supplementation become routine.

By Victoria Stagg Elliott — Posted June 29, 2009

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Chicago Physicians should consider assessing 25-hydroxyvitamin D in patients most likely to have low levels of the hormone. These patients should then be counseled about ways to improve their vitamin D status, according to a Council on Science and Public Health report adopted at the AMA's Annual Meeting.

"We need to get the word out to doctors to measure vitamin D levels in patients who might be deficient," said Sandra Fryhofer, MD, the member of the council who presented the report during the meeting.

The action was taken because a growing body of literature indicates that intake of vitamin D, which is primarily obtained from being exposed to the sun and drinking fortified milk, has gone down. Recommendations for how much is needed to be healthy also may be too low. Studies have connected vitamin D depletion to bone problems, some cancers, cognitive decline, cardiovascular disease, diabetes and several autoimmune conditions.

"The importance of vitamin D has certainly expanded beyond endocrinologists' interest in bone health," said Vineeth Mohan, MD, who was speaking for the Endocrine Society.

It's the latest move by medical societies and government agencies on this subject. The American Academy of Pediatrics published a statement Oct. 31, 2008, in Pediatrics doubling the recommended intake from 200 to 400 IU for babies, children and adolescents.

Examining vitamin D research

The Institute of Medicine's Food and Nutrition Board is reviewing the data, along with that for calcium, and is expected to come out with revised recommendations within the next two years. The issue also has come up at several endocrinology meetings, and some physicians recommend their patients take as much as 1,000 to 2,000 IU of vitamin D daily.

But delegates expressed caution about coming out with too strong of a recommendation. Research that low vitamin D levels are associated with worse health outcomes is compelling. But data are lacking that low levels cause problems and that increasing intake makes a difference.

There's also concern about balancing the risk for skin cancer since vitamin D is most easily derived from exposure to sunlight. For these reasons, the council also asked for continued research. The report also called for the AMA to educate physicians on the evolving science around vitamin D.

"Vitamin D is hot, and not just because it's a sunshine vitamin. ... The [associated] research is promising, but we still need clinical trials" Dr. Fryhofer said.

Physicians suggested that some patients, such as those who have dark complexions but, because of their religious beliefs, rarely expose their skin to sunlight could be assumed to be vitamin D deficient. They most likely don't need to be tested. Rather, a trial of vitamin D supplementation can be tried to assess whether this strategy relieves whatever symptoms they are experiencing.

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Meeting notes: Public health

Issue: Some organizations are lobbying to have obesity declared a disability, but this designation could interfere with physician counseling on the subject.
Proposed action: Oppose such efforts. [Adopted]

Issue: Concerns have been raised about the safety of conducted electrical devices being used by law enforcement officials and others.
Proposed action: Law enforcement departments and other agencies should design and implement guidelines, training and accountability on the use of these devices. These bodies should also have standard approaches to medical evaluation, management and postexposure monitoring. Additional independent research is needed to better understand the risks and benefits of these devices. [Adopted]

Issue: Male breast cancer is uncommon but tends to be diagnosed at late stages. Awareness of this possibility is low.
Proposed action: Recognize that breast cancer affects men as well as women, some men are at increased risk and heightened surveillance may be appropriate for a minority of men. Support Medicare and insurance coverage for screening and testing services for those at increased risk. [Adopted]

Issue: Hormones have been promoted to prevent aging, but there are many open questions as to the risks and benefits of taking those substances for that purpose.
Proposed action: Disseminate the Council on Science and Public Health report that found scientific evidence was lacking and, in some cases, long-term use may cause harm. Take the position that those who promote these treatments have a responsibility to support claims with well-designed, randomized placebo-controlled trials. [Adopted]

Issue: Americans' overall health continues to decline because of preventable conditions, many linked to overweight and obesity.
Proposed action: Make improving Americans' eating and exercise habits a priority, propose draft legislation that would establish innovative programs to encourage people to adopt healthier habits and work with partner organizations to educate patients on how to improve diet and increase physical activity. [Adopted]

Issue: The obesity epidemic is growing, but people do not have easy access to the nutritional information they need to eat healthily in restaurants.
Proposed action: Create a method for displaying calorie and other relevant information on restaurant menus and menu boards for all food and beverage items. [Reaffirm existing policy on nutrition labeling]

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