As you know, I’m not a huge vitamin pusher. However, I do realize the importance of supplementing babies’ diets – especially those of exclusively breastfed babies – with 400IU of vitamin D daily until the age of a year. I also pointed out, almost a year ago, that lactofanatic dogma – that breastmilk is perfect for all babies, always – has caused some AP/NPers to resist vitamin D supplementation for their babies, despite the research that shows that exclusively breastfed babies are prone to vitamin D deficiency and even rickets.
But science is finding that vitamin D has far greater importance than mere maintenance of bone health. Vitamin D receptors have been found in many tissues of the body, and low vitamin D levels have been associated with an increase in the incidence or as a possible cofactor in the pathogenesis of many diseases, including various cancers, high blood pressure, autoimmune disease, heart disease ,both types of diabetes, and possibly dementia. While most of the research has not proven causation and vitamin D is starting to sound a lot like the vitamin du jour, there is a strong case to be made that raising the vitamin D levels of the population to the levels now considered normal (30-100 IU/liter) will reduce the incidence of various illnesses.
Which is why I find La Leche League’s epiphany on the subject of breastfeeding and vitamin D more than a bit underwhelming:
(October 16, 2008) Schaumburg, IL – La Leche League International encourages all mothers to recognize the importance of vitamin D to the health of their children. Recent research shows that due to current lifestyles, breastfeeding mothers may not have enough vitamin D in their own bodies to pass to their infants through breastmilk.
In October 2008, the American Academy of Pediatrics recommended that infants receive 400 IU a day of vitamin D, beginning in the first few days of life. Children who do not receive enough vitamin D are at risk for rickets and increased risk for infections, autoimmune diseases, cancer, diabetes, and osteoporosis.
Vitamin D is mainly acquired through exposure to sunlight and secondarily through food. Research shows that the adoption of indoor lifestyles and the use of sunscreen have seriously depleted vitamin D in most women. The ability to acquire adequate amounts of vitamin D through sunlight depends on skin color and geographic location. Dark-skinned people can require up to six times the amount of sunlight as light-skinned people. People living near the equator can obtain vitamin D for 12 months of the year while those living in northern and southern climates may only absorb vitamin D for six or fewer months of the year.
For many years, La Leche League International has offered the research-based recommendation that exclusively breastfed babies received all the vitamin D necessary through mother’s milk. Health care professionals now have a better understanding of the function of vitamin D and the amounts required, and the newest research shows this is only true when mothers themselves have enough vitamin D. Statistics indicate that a large percentage of women do not have adequate amounts of vitamin D in their bodies.
La Leche League International acknowledges that breastfeeding mothers who have adequate amounts of vitamin D in their bodies can successfully provide enough vitamin D to their children through breastmilk. It is recommended that pregnant and nursing mothers obtain adequate vitamin D or supplement as necessary. Health care providers may recommend that women who are unsure of their vitamin D status undergo a simple blood test before choosing not to supplement.
Health care providers may recommend that women check their vitamin D level before choosing not to supplement? How about what LLL recommends? Not much of substance, apparently. I can just see an AP/NPer thinking, “Well, I’m white, live in California, and spend a lot of time out in the sun. So my breastmilk must be all-natural and perfectly calibrated as Nature intended. That advice surely doesn’t apply to me!”.
I have to say that in my practice, many women have requested, and in some cases I’ve initiated, vitamin D level checks among my patients. I think I may have seen one normal vitamin D level among them. While many of the women walk around covered up but for their faces and hands, not all the vitamin D-deficient ones do, and Israel is a very sunny country. Quite a few of my fellow family physicians who practice in more liberal areas of town have also found a high percentage of vitamin D deficiency among the women they’ve checked, modest dress code or not. Even among the lily white in a hot, sunny country, vitamin D deficiency is very common. We all stay indoors more, use sunscreen, and don’t get enough vitamin D from dietary sources. You can’t just assume that a healthy lifestyle will assure your milk is ‘perfect’. A strong recommendation that any woman considering not supplementing check her vitamin D levels ahead of time would be more to the point. So would letting go of the ‘breastmilk is perfect’ ideology and reiterating the AAP’s position that breastfed babies need direct vitamin D supplementation. But that is, apparently, too bitter a pill for LLL to swallow.
Another issue not mentioned in the LLL press release is that in order to pass enough vitamin D into their breastmilk, women need high doses of vitamin D supplements – some 5-15 times higher than the doses normally given to infants (2000-6400IU vs. 400IU daily). While even these high doses do not pose, as far as is known, any health concern to the mother, it’s far simpler to just give the baby 2 drops of liquid – and thus more likely to be performed consistently- than have Mom swallow multiple pills every day, if the primary goal is to ensure that Baby is getting enough vitamin D in their diet. Sad to say, that doesn’t necessarily seem to be LLL’s primary goal.