The Politics of Vitamin D: Questioning Universal Supplementation
Katherine Barber and Mishawn Purnell-O'Neal
Issue 117, March/April 2003
As early as the spring of 2003, the American Academy of Pediatrics (AAP) may recommend that all breastfed babies receive a daily supplement of vitamin D, based on the belief that breastmilk is deficient in vitamin D and can lead to rickets in babies who are exclusively breastfed. Such a recommendation is paradoxical: While breastmilk is supposedly the best form of infant nutrition (as mothers, physicians, and even infant-formula companies agree), it is somehow lacking in sufficient amounts of vitamin D. This policy could have far-reaching, potentially harmful implications for the work of breastfeeding advocates across the country, particularly in the African American community.
Nutritional rickets is a disease characterized by weak bones, poor bone development, and bowed legs, and is caused by a deficiency in vitamin D. (It can also be caused by cystic fibrosis, metabolic disorders, and celiac disease.) The human body needs vitamin D for proper bone growth and calcium absorption. Our primary source of adequate amounts of vitamin D is sunlight, or Ultraviolet B (UVB) exposure. Vitamin D is also found in such foods as salmon and egg yolks. Nutritional rickets is rare in the US, though over the past few years there have been new cases around the country. It's so uncommon, in fact, that until recently there was no national monitoring system to track and study the disease; the Centers for Disease Control (CDC) is just beginning to monitor it. Signs of rickets in infants include slow growth, seizures, the inability to stand or walk, curved bones, large joints, and bowed legs. In the 1920s, researchers discovered that the root of the disease was vitamin D deficiency; since then, many foods, including cow's milk, have been fortified with extra vitamin D.
Vitamin D-deficiency rickets is a public health issue that warrants attention, but not at the expense of breastfeeding. Media attention has mainly focused on exclusive breastfeeding as a cause of rickets; however, an increase in rickets cases may result from the reduced amount of time that people spend in the sun and from women who do not have adequate stores of vitamin D during pregnancy.
It is true that breastmilk has low amounts of vitamin D, but those low amounts are just what breastfed babies need. In rare cases, vitamin D supplements may be appropriate for some breastfed babies, such as those not exposed to the sun because of their parents' religious beliefs and those who live in regions where there is little sunlight.
Experts say that darker skin makes children more susceptible to rickets. This is because darker tones tend to protect the skin from a certain amount of ultraviolet rays, causing an almost natural deficiency in vitamin D. Michal Young, MD, a noted neonatologist and prominent breastfeeding advocate in Washington, DC, told us, " 'Dark-skinned' is a relative term and given to far too many variations. Also, climate conditions, such as cities with a lot of air pollution, can make sunlight a challenge for persons who are not as deeply pigmented."
Are African American or darker-skinned babies as susceptible to rickets as those who live in areas where sunlight is diminished? "Most babies with light-medium skin tones just need a little outdoor time, while darker-skinned babies need more outdoor time. Let's get the kids outside more, instead of giving them vitamin D," says Katherine Dettwyler, PhD, Adjunct Professor of Anthropology and Nutrition at Texas A&M University.
A natural alternative to vitamin D supplementation is exposure to sunlight, but how much sunlight? To make enough vitamin D, a baby in a diaper needs a total of only 30 minutes of sunlight a week-less than five minutes a day. Fully clothed and without a hat, a baby would need two hours of sunlight a week, or about 20 minutes a day. Medium to darker skin tones need a little more time in the sun.
Becky Saenz, MD, IBCLC, Associate Professor of Family Medicine at the University of Mississippi Medical Center, believes the AAP may have concerns about recommending sunlight exposure because of the danger of skin cancer. She points out, "There is a vast difference between recommending that it's okay for baby to sit in the grocery buggy while mom puts the groceries into the car in the early morning or late afternoon, and recommending nude sunbathing at noon."
Maternal Diet: Another Possible Alternative?
Maternal vitamin D status is crucial to the vitamin D status of the breastfed infant. The amount of vitamin D stores a newborn baby has is directly related to its mother's vitamin D stores. Several studies have documented that the vitamin D status of the mother can be raised by increased exposure to UVB rays, supplements, and increased consumption of food with vitamin D. For instance, healthy individuals who eat two to three servings of salmon per week have met all their vitamin D needs. Salmon is also an excellent source of docoshexanoic (DHA), the long-chain polyunsaturated fatty acid essential to visual and brain development, which is found in human milk but is absent from most infant formula. The amount of DHA in breastmilk also varies with the maternal diet. And just as there are those looking to cash in by adding DHA to infant formula, there is the same danger with the issue of vitamin D supplementation. Fortification of infant formula with DHA has a potential value of $300 to $400 million for the science and technology industry.1 Just as the March of Dimes promotes the pre-conception use of folic acid as a way to reduce the risk of birth defects, public-awareness campaigns could promote the importance of women's vitamin D status in their childbearing years.
What's a Mother to Do?
Among experts in the pediatric and breastfeeding fields, there is a lack of consensus about the issue of vitamin D-deficiency rickets. Many breastfeeding advocates have a problem with a "one size fits all" approach to vitamin D supplementation. Some headlines have claimed that, with a growing number of African American women choosing to breastfeed, there has been an increase in the number of reported cases of vitamin D-deficient rickets. This misleading statement in effect questions the confidence of African American women and their ability to provide quality nutrition for their infants. It also perpetuates the myth that technology and science are needed to complement and improve breastmilk.
Another potential result of this type of recommendation is that women may choose not to initiate breastfeeding at all. Among African American women, breastfeeding rates are often 20 percent or more lower than those of whites and Hispanics. Breastfeeding promotion in this community has long been a challenge, and this recommendation may actually deter African American women from breastfeeding. Consequently, both mother and infant would miss all the benefits associated with the breastfeeding experience. Katherine Dettwyler says, "It makes it more of a hassle to breastfeed, and it makes it sound as though breastmilk is lacking while formula is perfect. Already, too many people think formula is a risk-free option to breastfeeding, when it clearly isn't. I'd like to see some side-by-side comparison of the risks of rickets from lack of vitamin D in breastmilk to the risks of everything else from [the] lack of pretty much everything in formula."
Breastmilk is the only form of nutrition designed to meet a baby's specific needs. Some babies have circumstances that warrant medications and/or supplements; but this should be on a case-by-case basis. If experts begin to say that breastmilk is best, but that all breastfed babies need a supplement, of any sort, a Pandora's box is opened. Formula companies will heartily feast on this information. Their marketing may include taglines like, "Formula X has everything your baby requires, so there's no need to worry about rickets." In fact, formula manufacturer Mead Johnson has already capitalized on the belief that breastmilk isn't quite enough. Advertising for its product Di-Vi-Sol (vitamin D drops) says, "With Breast-feeding and D-VI-SOL Baby's Nutrition is Complete. D-VI-SOL-A daily dose of peace of mind. You know that breast-feeding is the best form of feeding you can give your baby. However, even the superbly balanced nutrition of breast milk contains only about 10% of the recommended daily intake of Vitamin D for infants."
This ad tells the consumer and the general public that breastmilk alone is not good enough for babies. Formula manufacturers will gain in a number of ways from this kind of recommendation, and their marketing will begin to send subtle messages that their product is more complete than breastmilk. Sales resulting from a universal recommendation of vitamin D would also provide more residual income for the formula companies at the expense of exclusive breastfeeding. We need to be very cautious when professional organizations make broad policy statements that have huge health implications. Not all babies are at risk of developing rickets; too much vitamin D, in fact, can cause an excess amount of calcium in a baby's system, potentially leading to kidney or brain damage, lethargy, seizures, coma, pancreatitis, and cardiac arrhythmias. What happens if a baby is given an overdose of vitamin D drops? What if a mother chooses not to give the drops?
Who will pay for the drops? What if a mother can't afford to buy them? Medical doctors will also be affected by this recommendation. Some will prescribe the drops across the board rather than on an individual basis. For those doctors who don't promote breastfeeding to their patients, this may reinforce the doctors' lack of confidence in breastfeeding as the most viable option.Many unanswered questions regarding the supplementation issue remain. What are the short- and long-term health consequences of providing vitamin D to infants who are not vitamin D-deficient? What are the psychological and physiological impacts on breastfeeding? Have the risks been weighed against the benefits? Clearly, there is a need for additional research on breastmilk, vitamin D, rickets, and the disease's
Saturday, August 30, 2008
Tuesday, August 26, 2008
Embarking on this search I was mislead by some bad information in Dr. Sears' The Baby Book. He tells parents that the best shoe for a beginning walker are, not in these exact words, the old school lace up white leather bootie. I mean c'mon, really? I was having a hard time wrapping my mind around this, style factor aside, it sounded like prison for her feet! Feet that love being nude.
Armed with my understanding of the importance of well fitting shoes, the knowledge of her still developing spine and that direct connection it has with our feet, and a desire to make the transition comfortable and smooth I searched. Interesting stuff out there ladies -- as instinct may have already guided you that out-of-style bootie is bad. It's restrictive and can hinder proper development of their feet on up. Here is an observation, I found on the web, by Dr. Lisa Moore, Chiropractor:
During foot development, it is important for bones, muscles, blood vessels and nerves to have room to grow without restriction. As the beginning walker stands up and takes the first tentative steps, the muscles of the feet grip the floor and the toes separate to help the child have better balance and control. If feet are confined within a rigid shoe, the toes cannot operate in this way, nor can the muscles of the foot and ankle develop the strength necessary to hold her upright.
Foot health depends upon the flexibility of the structures involved --- this begins in infancy and continues as we grow. From a chiropractic standpoint, spinal health is connected to foot health; If we wear rigid shoes the bones cannot move freely.
In a nutshell mothers the best is bare; up from that the next best are soft soled shoes with a gripping bottom. Make sure they are made from a breathable material like leather and don't have too thick a sole -- flexibility is key. The shoe need not be a high top, although that can make it more of a challenge to get off, and should have about a half inch wiggle room at the toe.
Here are some brands you may like: PlatyPaws, Foosies and Robeez. They are all great and come in some cute styles. I have yet to purchase a pair but at least going into it now I feel better about the whole thing -- hope to have been a help to any of you mom's out there trying to find the shoe that fits too.
Wednesday, August 20, 2008
In my research I came across Cod Liver Oil -- An excellent source of Vitamin D. I wondered if there was a catch? Is it high in Mercury levels being a fish and all? What about taste? There seemed to be all these flavored kinds which lead me to question just how icky tasting it might be -- would my daughter even take it if it tasted fishy or even like spiced apple? I didn't want to go flushing money down the drain again so I'm looking into it first.
Heres the scoop as I understand it: Cod Liver Oil is a great source of Vitamin D and, because mercury is supposedly water soluble, it is present in the flesh not the oil. High quality brands of Cod Liver Oil are also purified of Mercury and other contaminants (It seemed like Carlons, lemon flavored, may be the way to go) but none of this means your kids will take it. Does anyone know how it tastes? Mothers, have anyone of you tried it? Please let me know.
Also, as I understand, seems like during summer months sunlight is sufficient for Vitamin D -- Winter months when sun exposure isn't readily available that's when you may want to think about Cod Liver Oil. The catch, yes there is one, was that Cod Liver Oil also has Vitamin A added and it is possible to get too much A in your diet when using this supplement. I won't go into it here but you can look up for yourself what too much of a good thing, Vitamin A, can do.
So, use with caution?
Anyone ever tried Cod Liver Oil? Would love to hear your experience. And Moms, a little sunlight a day is good -- we all need it.
Thursday, August 14, 2008
I came across some interesting facts about fluoride; Here's an excerpt from a website -- www.drjaygordon.com (look for it on the links page (he also lists some other links that may be of interest as well on his site).
There is, as always, two sides to the argument but the fact that it is a debate at all makes me question what's really needed to maintain healthy teeth. The long term side effects of fluoride, a toxin it seems to your system, were not researched when our government mandated we have it put in our drinking water. Perhaps the debate can be won that at low levels fluoride may not be so damaging but at high levels? -- Well it's like that old idiom about moderation being key right? This information, well known this day and age, is out there so, when I found out that Danon was releasing a fluoride beverage for kids marketed as a better option to soda (c'mon they're both no good) I was stunned. I mean what's the deal moms? All too often these days I feel like I took the red pill and went down the rabbit hole -- no regrets -- It's just that around every corner there's another old time myth being debunked that serves as a reminder of why I have such little faith in the pharmaceutical industries of our great nation.
New research proves old-time dentists' premise was wrong. Fluoride's possible benefits, if any, are topical. So there's no good reason to swallow fluoride or put it into the water supply.
The old dogma is beginning to unravel. British researchers report in the British Medical Journal that fluoridation studies are flawed. A Canadian Government report found fluoridation does more harm than good. A US National Institutes of Health Panel found most tooth decay studies, including hundreds on fluoride, scientifically invalid. Even UNICEF, the organization that protects children, reports, "more and more scientists are now seriously questioning the benefits of fluoride, even in small amounts."
What's more unbelievable is that the chemicals most used to fluoridate drinking water are silicofluorides, contaminated waste product of industry, that were never safety tested on humans or animals. Meanwhile we are conducting a massive toxicological experiment. Our children are the test subjects
Silicofluorides are linked with children's increased lead absorption. Studies link fluoride chemicals to bone fractures, lowered IQ, thyroid dysfunction, cancer, allergies and more.
And the American Dental Association is working on a new and improved cavity fighter, even better than fluoride - calcium and phosphate - the minerals they overlooked in the early 1900's.
Saturday, August 9, 2008
Turns out, mothers and fathers, this is a great consolation prize. The Los Feliz 3 theater on Vermont has a Wednesday 10:30am showing of all its movies -- the price is reduced to $6.00 and you can see new releases on the day they come out without a worry about getting a good seat. What a deal! And, the theater is pretty much all yours so if your child is a feeling a little feisty or fussy no worries; there are other kids that may be playing in the aisles, nursing and letting out occasional cries too.
At The Grove, though I haven't been here yet, I know they have a Monday morning showing at 11 am. I hear they are very accommodating and add a few extras like a changing table in the aisles? or maybe it was that they had toys out to play with? At any rate I'll have to scope this out and get back to you.
If you're not in California and maybe a trip to the movies with your toddler seems impossible -- you'd disrupt everyone -- be inspired and ask your local theater to do a Mommy and Me time? What's the harm in trying -- the neighborhood could probably use it.
Tuesday, August 5, 2008
In my efforts to nourish my daughters body well I make homemade organic foods that are frozen in cubes that are later thawed when they are to be eaten. I enjoy cooking so this is no biggie; It's actually been a lot of fun and made me more aware, not that I have ever really been a junkie eater or anything, of how I myself eat. The laws of a balanced diet and joy of foods combined -- I am the one setting the example and foundation for what she perceives as "palatable." So it's time to get creative because, after all, would you want to eat bland food? I wouldn't, I like spice! I like flavor and I want her to grow up open minded to it all so, when seven months hit and the green light flashed for adding spices, I did.
(Check out these links: wholesomebabyfood.com and weelicious.com. They've got great food inspiration and are informative as well. I also learned some good to know stuff about the benefits of flax on askdrsears.com that may be interesting to you as well.)
Now back to spice -- we've tried: coconut butter, basil, garlic, nutmeg, cinnamon, oregano, rosemary, pepper, ginger, and vanilla to name a few and are excited to explore foods I'd never before even tried like cherimoya. I mean everyday, without even trying, my daughter teaches me something new; a new way to season a new food to try. This is fun stuff moms! The local farmers markets are brimming with seasonal produce that is filled with vibrant color (try a red carrot for example), fresh taste and rich smells (like those sweet, round, buttery colored peaches that burst with a juice that drips down your chin when you take a bite). But I'm not here to really talk about spice, just threw it in as a mind-opener, I'm here to share with you something I came across the just the other day.
So, as I was sauntering down the isles at my local whole foods supermarket thinking, "I aught to package this homemade baby food I make, not all mom's have the time to cook. Given the option though I'd bet they'd rather be feeding homemade organic foods to their kids." and then Bam! -- Homemade Baby -- There it was, my (obviously not so original) idea. Some mom (I'm assuming) had gone ahead and done it! Bravo mama! I tried a sample of the apple sauce that some young lady was handing out in little cups and it was deeeeelish. (I know I rambled a bit before getting to the good stuff and have no clue about the other flavors) -- An option exists for us mamas when we can't cook because we are traveling, working, mothering for goodness sake (we know that's a full time job) but want to feed our babies better.
here's the link: www.homemadebaby.com -- Mind you I only tried a sample but have read a little about the company and like what they're about, not to mention the food really was good and made without sugar or preservatives -- just vacuum packed and found in the refrigerated section of your local wholefoods. I asked, if you were wondering, about if the food requires refrigeration (this may be a problem travelling right?) and the "sample girl" informed me that, though it is recommended to keep the containers refrigerated, the food can be kept for a period of time un-refrigerated. So moms, check it out -- because, alas, even the most die-hard homemaking food cube freezing mom out there needs an alternative sometimes :)