Thursday, March 1, 2007

Vitamin D - The Controversy lives

A new study released a few days ago is raising concerns about the levels of Vitamin D in American pregnant women and babies. The study funded by the National Institutes of Health, found that 80% of African-American women and over 50% of White women had Vitamin D levels that were "too low" at delivery. They also found that the newborns had low levels of vitamin D - 92.4% and 66.1% respectively had low levels despite 90% of the moms taking the recommended amount in a prenatal vitamin.

I think this study raises more questions than answers. First of all, there is no agreed upon optimum level of Vitamin D intake. Part of the problem is that Vitamin D isn't really a vitamin, it's a hormone. Your body synthesizes it from sunlight. Vitamin D is truly a lack of appropriate sun exposure. However, all the concern about protecting oneself from skin cancer (which is valid but needs to be balanced with our need for fresh air and sunlight) has created a culture afraid of the sun and its rays.

I would be interested to read the study. Were the women encouraged to eat a diet high in foods that provide this essential element of good health such as Salmon, shrimp, Cod and cod liver oil, eggs and of course fortified dairy and other products? Now cod liver oil can be taken in a pill - no more yucky spoonfuls of fishy oil! It is difficult if not impossible to eat your way to your necessary amount of Vitamin D, but thinking about it as part of your dietary planning is a smart thing to do.

Were the women encouraged to get a small amount of sunlight each day/week Spring through fall? That is the easiest and best way to get "Vitamin D" - the way your body was meant to have it, by making it! Cynthia Good Mojab calls vitamin D deficiency, sunlight deficiency. How would you cure a deficiency in sunlight? More sunlight! Read her article from LLLI's Breastfeeding Abstracts here.

What levels are dangerous? When does your level of Vitamin D leave you more susceptible to the various chronic diseases that it is believed to help protect against: breast cancer, ovarian cancer, type 2 diabetes, heart disease and more? Just about every study on Vitamin D concedes that we can and should all have higher levels but don't . Yet we don't all have cancer; we don't even have high amounts of rickets or osteomalacia (rickets for grown folks). If we are supplementing and it is not enough, maybe it's time to put down the sunscreen a little and enjoy the sunshine a little more.

I understand that public health messages are supposed to be simple and for the masses. However, I think a blanket ban on sun and blanket recommendation of vitamin D supplementation isn't getting us to where we need to be.

You may be wondering what this has to do with breastfeeding. Well, the NIH and AAP recommend Vitamin D supplementation for ALL breastfed babies, regardless of skin tone based on the amount of Vitamin D found in breastmilk. This is flawed for two reasons. One, the vitamin D content of human milk varies from five to 136 IU per liter and is not the constant 25 IU vitamin D per liter claimed on the NIH website. Secondly, humans are meant to synthesize Vitamin D from sunlight through skin NOT ingest it through food. So calling the baby's food source deficient is unfair because it was never meant to be the source. Just because you can add enough Vitamin D to formula to have the magical approved RDI listed on the label, doesn't mean the baby absorbs it.

From the NIH website:

Infants who are exclusively breastfed
In infants, vitamin D requirements cannot be met by human (breast) milk alone [4,19], which usually provides approximately 25 IU vitamin D per liter [20]. Sunlight is a potential source of vitamin D for infants, but the American Academy of Pediatrics (AAP) advises that infants be kept out of direct sunlight and wear protective clothing and sunscreen when exposed to sunlight [21]. The American Academy of Pediatrics (AAP) recommends a daily supplement of 200 IU vitamin D for breastfed infants beginning within the first 2 months of life unless they are weaned to receive at least 500 ml (about 2 cups) per day of vitamin D-fortified formula [20]. Children and adolescents who are not routinely exposed to sunlight and do not consume at least 2, 8-fluid ounce servings of vitamin D-fortified milk per day are also at higher risk of vitamin D deficiency and may need a dietary supplement containing 200 IU vitamin D [20].

Formula fed infants usually consume recommended amounts of vitamin D because the 1980 Infant Formula Act requires that infant formulas be fortified with vitamin D. The minimal level of fortification required is 40 IU vitamin D per 100 calories of formula. The maximum level of vitamin D fortification allowed is 100 IU per 100 calories of formula [22]. This range of fortification produces a standard 20 calorie per ounce formula providing between 265 and 660 IU vitamin D per liter.


Does the risk of skin cancer from sun exposure outweigh the known risks of formula? Did the AAP research that before making this recommendation?

Am I supposed to exclusively breastfeed or wean to some formula by two months to make sure my baby is getting enough vitamin D? Is it any wonder that the "benefits of breastmilk" don't outweigh the "benefits of formula feeding" to most moms?

It is statements like these (and their underlying attitudes and misunderstanding of human milk) that makes breastfeeding promotion difficult. How can breastmilk be both "the gold standard" and "deficient and needing supplementation"?

For more information on this issue see LLLI's FAQ on Vitamin and fluoride supplements,'s Does my Baby need vitamin D supplements and The Politics of Vitamin D: Questioning Universal Supplementation by Kathy Barber and Mishawn Purnell-O'Neal.

Now, next time the sun is out, go outside and enjoy yourself! Get your RDI of sushine!

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