Leon H. Rottmann, Ph.D., Professor Emeritus, University of Nebraska-Lincoln
Lifeline, Fall 1997, Vol XV, No 4, pp 1
I'm not sure that any one of us can truly appreciate the "vitamin use rug" until it's pulled out from under us. My question is whether that has to happen before any one of us can reach the teachable moment.
It's likely well-established that most celiacs don't need to worry about getting enough nutrients once they are stabilized and on an appropriate clinical diet adjusted to their condition and appropriate for them at their particular age and stage in life. But should we be concerned about getting too much?
Reports in two national journals over the summer and seven patient inquiries in recent weeks to the CSA office related to both women and men who had lost bone mineral density from taking too much vitamin D. All celiacs had been screened for or were under treatment for osteoporosis or low bone density.
All patients were taking some combination of dietary supplements, some of which contained 3,600 to 5,000 (IU) international units of vitamin D. The recommended dosage and generally accepted ranges are between 200 and 800 IU. And those levels include intake from both food and supplements.
Adequate levels of vitamin D and calcium are important for preventing osteoporosis, but too much [as well as too little], disrupts normal calcium metabolism which then often results in a loss of calcium from bones. Once the patients stop taking excess vitamin D, their bone density typically returns back to normal over a 2- to 3-year period.
Adverse reactions to vitamin and mineral supplements are seen as rare and most people are likely using them safely. But, now that both the literature ad case histories are indicating that more people are taking supplements above the (RDA) recommended daily allowance, perhaps it is time once again for each one of us to review some common sense caution. Perhaps it is only to deal with our temptation to think that if a little is good, more must be better.
Fortunately, for all of us, the new release in the next weeks of (DRI) Dietary Reference Intakes as they will be called, will include at least three reference values for each nutrient: the estimated average requirement, the traditional RDS and a tolerable upper limit. It is expected that these values will be provided by age and sex groupings.
But again one of the critical points for celiacs is that only healthy adults should take nutrient supplements without a physician's monitoring. That recommendation comes to us since guidelines are based on studies of healthy people; thus anyone with a disease or chronic medical condition should take supplements only under medical supervision. Without heeding that caution, there goes that rug.
Annals of Int Med, Aug 97
Council for Responsive Nutrition
Healthnews, Aug 97
CSA Library Series is a collection of articles that pertain to celiac disease and dermatitis herpetiformis. Most of these articles have appeared in CSA’s quarterly newsletter, Lifeline, which all CSA members receive. Historic articles included in these resources may or may not include updated notes. Updated information indicated in red type. Articles represent the work of the author.