VITAMIN D SUPPLEMENTATION

by drnieman on October 6, 2015

in Monthly

In 2008 the American Academy of Pediatrics held a press conference in Boston explaining why an expert committee advising the AAP suggested that babies who breastfeed be given 400 IU daily of Vitamin D3. Since then some jurisdictions in North America increased the supplementation given to babies from 400 IU to 800 IU per day.

In a provocative paper published in the October edition of Pediatrics, researchers from South Carolina argue that it may in fact be a better idea to give Vitamin D to the lactating mother, rather than the baby. One reason for this switch is that not all breastfed babies receive daily vitamin D supplements—parents forget, get distracted or claim that some infants spit up more when given Vitamin D.

The paper published in Pediatrics, by Dr. Hollis and colleagues, is praised in an editorial written by Dr. Lydia Furman as “elegant.” It goes on to say that, “When the curtain falls we learn that 6,400 IU of daily maternal vitamin D3 for 6 months successfully supports maternal vitamin D status. It also documents that this produces sufficient vitamin D levels for breastfeeding infants.”

A few years ago the Institute of Medicine came out with a position statement on Vitamin D supplementation. It suggested that for adults no more than 4000 IU per day is needed.

The new research probably will be met with skepticism, concern or a plea for more research before we will see a “buy-in” from the majority of doctors. For now the notion of giving babies 800 IU per day may remain the standard of care, but I anticipate that in future we will see a new recommendation: give the lactating mom the vitamin D so that her milk will meet the needs of the baby—as opposed to giving babies the vitamin D.

We know that when a lactating mom takes 400 IU of vitamin D3, or even 2400 IU of D3 daily, it will not meet the needs of babies.

Many of the previous papers have focused on rickets in babies who are nursed exclusively, but not given vitamin D supplementation. I have a problem with this approach, because rickets deals with a deficiency only. What about a less obvious issue such as a Vitamin D insufficiency? Can an insufficiency be associated with more allergies later? Could it be associated with poor bone health, but not absolute extremes such as rickets? The answer is still evolving, but the concerns remain plausible.

Some dermatologists have done a great job of instilling fear. They warn against the dangers of even small amounts of sunshine. These well-meaning experts are most likely motivated by a dramatic increase in skin cancer associated with excessive sun exposure.
In the past ten years we have learned that where we live determines our need to take vitamin D supplements—-anywhere north of the latitude of Atlanta is a risk factor.

In addition, a darker, heavily -pigmented skin is a risk for low Vitamin D; so is being obese. Unfortunately some doctors continue to tell patients to first apply sunscreen and then go out in the sun—ideally there should be no sunscreen applied, thus allowing for at least 20 minutes of natural, gentle and healthy unfiltered sun exposure. Following natural sunshine for a few minutes only, sunscreen must be applied for proper protection against damaged skin.

Overall I keep it simple by suggesting to families to go outside on a sunny day at 12h00; if your shadow is taller than you are start taking Vitamin D; if your shadow is shorter than you are stop taking vitamin D.

Not everybody can afford vitamin D supplements and natural sources from sun and food may be ideal, but this is not always feasible or consistent—especially from September to April.

The Pediatrics study is a historic breakthrough and well-designed. Practically some moms may want to go ahead and take 6400 IU per day—even before experts support that. Others may be more conservative by continuing to supplement their babies while waiting for further research which support the notion that we can increase Vitamin D in breast milk by giving mothers more than 4000IU per day.

The topic of vitamin D is not going away. Unlike other vitamins—such as Vitamin E and Vitamin C —where the initial enthusiasm fizzled out, the story of vitamin D continues to expand. For more information on the still emerging science of Vitamin D consider subscribing to the Vitamin D Newsletter, published by the Vitamin D Council. (The URL is www.vitamindcouncil.org The Twitter handle is@VitaminDCouncil)

It is important to remember that Vitamin D3 is a fat soluble vitamin and thus, if over-dosed, it can accumulate in the body. But even thought the Institute of Medicine sets the upper limit at 4000 IU the Endocrine society sets their upper limit at 10000 IU per day—thus the maternal dose of 6400 IU per day should not be seen as unsafe.

DR.NIEMAN IS A COMMUNITY PEDIATRICIAN WITH CLOSE TO 30 YEARS OF EXPERIENCE. HE HOSTS WWW.HEALTHKIDS.CA BLOGS WEEKLY ON WWW.DRNIEMAN.COM AND RECENTLY PUBLISHED HIS FIRST BOOK “MOVING FORWARD” HE HAS COMPLETED 97 MARATHONS.

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