Vitamin D/ Do you need to supplement? 2017

Vitamin D/ Is your baby getting enough? Are you???

Food superstars come and go. One minute something is going to cure all of your ills and the next minute it might be considered poison. (Who agrees with me that as long as chocolate and wine are considered to have some health benefits, they should stop doing further studies?)

One of the current favorite good guys is vitamin D. At the same time that scientists were stressing the importance of this vitamin, they were also discovering that many folks are surprisingly quite vitamin D deficient without being aware of it. There are 2 forms of vitamin D: D2 and D3. Most experts are in favor of focusing on D3, which is the more natural form.

Years ago, vitamin D deficiency was most associated with Rickets (a disease that causes very soft bones.) More and more recent studies are finding that vitamin D levels are also very important well beyond good bone health. Deficiencies are linked to multiple illnesses including diabetes, cancer, heart disease and even mood disorders. There are also current studies underway to see if there is a link between low Vitamin D levels and increased allergies. Other studies are linking D deficiency to insomnia and ADHD. There have been studies linking Vitamin D and cognitive health in older folks.

Just recently a large-scale meta-analysis using more than 10,000 participants concluded that vitamin D supplementation may help to prevent acute respiratory tract infections. Let’s make sure our babies are getting enough.
For several years now, the American Academy of Pediatrics has recommended that all breastfed babies start getting 400 IU of a vitamin D supplement within the first few days of life. (IU stands for international units, which is a common way that vitamin D is measured.) Quality infant formulas have vitamin D in them. Babies who get 32 ounces of formula per day have their needs covered.

But what about the majority of our babies who are partially or completely breast fed? I instinctively like to believe that breast milk is  a "complete source" for all of your baby's needs. In the case of vitamin D this is not necessarily the case. It comes down to the mom.

The only way a baby is getting enough D through the breast milk is if mom has a good level. Unfortunately, the segment of the population who test the lowest for vitamin D are pregnant and breastfeeding women.  If you are a nursing mom and you are deficient, your baby is simply not getting the amount that they need. There are some studies that claim that a nursing mom might need to take 4,000 IU/daily to be sure the baby is getting the suggested amount of 400 IU through her milk. Giving vitamin D drops directly to the baby can take the guesswork out of this. If you do end up giving your baby vitamin D supplements, one of the most common brands is the Enfamil D-Vi-SOL. One dropperful is 1 ml. This gives the daily dose of 400 IU.

Babies seem to tolerate this well. There are some other forms out there that give 400 IU in each drop! That is quite a difference. It is very important that you pay attention to the form that you are giving.

If you are giving your baby a multi vitamin supplement like Poly-Vi-Sol, that already has the D in it. Be a label reader! While vitamin D is one of the fat soluble vitamins, you cannot get "too much" from sun or diet. But as with any supplement, you don’t want to overdo it. Most studies suggest that the upper limit for safe supplementation is 1,000 IU/day for babies or 4,000 IU for adults. There are some current studies taking place that may in fact raise that level, but as of now I wouldn’t recommend going beyond that upper limit unless you are working closely your personal physician.

Children over the age of one, and all adults, should make sure they are at the very least getting 600 IU daily.  Milk and orange juice that have D added, some fatty fish, and cod liver oil are on the short list of good dietary sources for vitamin D, but a person would have to drink ten tall glasses of vitamin D fortified milk each day just to get minimum levels of vitamin D into their diet.

Other foods like some mushrooms and eggs will get you a bit, but not enough to begin to make a dent in the daily requirement.

Historically much of our vitamin D is/ was from sun exposure. Folks who live in sunny climates generally have higher levels. Darker pigmented skin has a harder time absorbing it. Being out in the sun, unprotected for 30 minutes 2 or 3 times a week would probably give most people the amount they need. But wait!! Do we really want to expose ourselves and our children to the risks associated with sunburn? To compound things, the rays of natural sunlight that produce vitamin D in your skin cannot penetrate glass. This means you can’t get vitamin D from indirect sunlight in your car or at home,

In fact, our recent healthier sunscreen practices are quite possibly the cause of our lower vitamin D levels. Weak sunscreens (such as SPF 8) can block Vitamin D by up to 95%. It is hard to find a balance. Some exposure is healthy, but overdoing it is problematic, Sunburn and an elevated risk of skin cancer don’t seem like a sensible answer.

If you are a nursing mom and are one of the many folks out there who has a low level, it is very important that your baby get the vitamin D that they need (and yourself as well !!) In our office we are not wedded to babies receiving a daily supplement as long as you are sure that they are getting enough through their milk intake. In any case, giving your baby a daily vitamin D supplement is certainly harmless if giving the proper dose. If you choose to skip the vitamin D recommendation, please consider getting a blood test to see what your level is. The recommended test usually ordered is a 25-hydroxy vitamin D level. There is some debate about what the proper level should actually be, but everyone seems to agree that:

• < 12ng/ml is severely deficient.
• 12-20 ng/ml is still not adequate
• 20-50ng/ml  is a reasonable range of normal

40% of folks tested in this country are low!! Please make sure that you and your baby are not one of those. Daddies, you need it too!!! My husband found out at his last physical that he was deficient. The first visits to the office with your new baby are loaded with various things to consider. If the vitamin D discussion didn't make the list and your baby is several months old before you  are hearing about this for the first time, don't stress. This is not just a recommendation for newborns,it  is a life long health issue. Now you know and can make a vitamin D plan for your family.

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