Vitamin D and breastmilk … what’s a babe to do?

You know that breastmilk, your milk, is the ideal and superior food for your baby.  It has immunological properties, just the right amounts of protein, fat, sodium, and fluid for your baby at his current age, and it changes depending on the time of day and when the last feeding was.  Even mothers who aren’t able to eat a great diet due to access to food, allergies, or other reasons, produce breastmilk that is nutritionally superior to anything else they can feed their babies.  Why, then, is there controversy over vitamin D?  Why do our pediatricians tell us to supplement our breastfed babies starting in the first few days of life, if we’re feeding them our complete, ideal milk?

The news you’ve heard is true: for many, many mothers, our milk does not confer the amount of vitamin D our babies need (400 IU/day) to protect them from rickets, a disease that causes softening and weakening of bones.  The American Academy of Pediatrics recommends in its 2008 policy statement:

“A supplement of 400 IU/day of vitamin D should begin within the first few days of life and continue throughout childhood. Any breastfeeding infant, regardless of whether he or she is being supplemented with formula, should be supplemented with 400 IU of vitamin D.” (Pediatrics 2008; 122(5):1142-52)

If our milk is ideal, “perfect,” even, why is a supplement recommended?  Is this another booby trap to make us think our own milk is inadequate?

Let’s start with a brief introduction to vitamin D.  It sounds like a nutrient, because we call it a “vitamin,” but it’s actually a pre-hormone, which gets converted in our bodies to another substance (1,25(OH)D).  The 1,25(OH)D then functions in our bodies to help regulate our blood calcium levels.  Of course, we know calcium is important for healthy bones, but you might not know that if your blood calcium is not quite right, you’re going to feel terrible.  Too much calcium and you’re going to lose your appetite, feel nauseated, fatigued; too little and your blood pressure will drop, your heart might not beat regularly, and you’ll struggle to stay standing, let alone functional.  In addition to calcium regulation and bone mineralization, vitamin D affects lots of other body systems, most notably our immune function and the cells in our pancreas that affect insulin production and blood sugar metabolism.  There is also observational evidence (studies that show a relationship but can’t necessarily prove cause and effect) that vitamin D is associated with such conditions as diabetes, rheumatoid arthritis, multiple sclerosis, prostate, breast, and colon cancers, and respiratory infections/flu, among others.  So, clearly, vitamin D is important in our bodies.  A vitamin D researcher, Dr. Reinhold Vieth says vitamin D is to the body as paper is to an office: the office can still do its business without paper, but operations will be compromised.

The problem for mothers and babies starts because many mothers are deficient in vitamin D in their pregnancies and after delivery.  One collection of data among women of childbearing age in South Carolina found that more than 50% of these women had vitamin D levels (measured by a blood test for 25-hydroxy-D, or 25(OH)D) lower than 20 ng/mL, and 81% of this same sample had vitamin D levels lower than 32 ng/mL.  While the Institute of Medicine’s 2010 report on vitamin D intake in the United States and Canada suggests 20 ng/mL as an appropriate level of sufficiency (because it is supportive of bone health, the only outcome that has been proven to have a cause-and-effect relationship with vitamin D), there are other data that recommend 30 or 32 ng/mL as a better measure of vitamin D sufficiency (because the observational outcomes regarding other diseases and vitamin D seem more favorable at this level).  Regardless of which standard we are applying, there is evidence that a large number of mothers are going into pregnancy with lower than optimal levels of vitamin D, which results in babies being born with lower levels, and the milk of mothers containing less than the ideal amount of vitamin D.

How did this happen?  We used to hear that we got enough vitamin D just from casual sun exposure on our face and hands, since our bodies produce vitamin D. We know now that isn’t necessarily true.  While our bodies make 10,000-20,000 IU of vitamin D after 15-20 minutes of unprotected sun exposure over most of our bodies (think swimsuit on the beach in July), if we live in northern latitudes (anywhere north of Atlanta, research shows), the sun’s rays can’t do their job for most of the year.  Basically, you can make snow angels outside, naked, all afternoon and not make any vitamin D if you live in New York and it’s February.  Those with darker skin colors will take up to 5 times as long to make the same amount of vitamin D under ideal conditions.  Remember, this is unprotected sun exposure … sunscreen blocks the vitamin D-making rays.  This is a big reason why we, as a population, are finding lower vitamin D levels.  The motivation to avoid skin cancer is legitimate.

The Institute of Medicine, in its report in November of 2010, recommends 600 IU/day as our daily intake, however, vitamin D is difficult to get from diet.  There are some foods that are fortified with vitamin D2 (our bodies convert that to D3, then convert the 25(OH)D to 1,25(OH)D), and other foods, like certain fish, that are naturally good sources of vitamin D; but most Americans get only 10% of their vitamin D from dietary sources.

In addition to how far away we live from the equator, there are other factors that affect our vitamin D status.  A body mass index over 30 is one; being over age 70 is another (and the IOM recommends extra vitamin D, 800 IU/day for this population). Of course, if we are inside most of the time and we use sunscreen or cover our bodies with protective clothing, even if we lived ON the equator, our vitamin D status would likely be lower than is optimal.

So, what’s a babe to do?  It is very important to keep in mind that breastmilk is still the superior infant food, and is, regardless of your vitamin D status, the very best you can feed your baby.  Your baby does need vitamin D, though, and you have options.

First, you can (and should) have your own level tested.  While the level required to make your milk have 400 IU/day of vitamin D is higher than most of us can achieve with the Institute of Medicine’s “tolerable upper intake” of 4000 IU/day (check with your doctor before supplementing with this much, there could be valid reasons this is NOT a good idea for your body), research by Dr. Carol Wagner and Dr. Bruce Hollis indicates that supplementing the mother with enough vitamin D to significantly raise her level can solve the problem of deficiency of both the mother and the baby, without toxicity to the mother and without having to offer anything to the baby other than mother’s milk.  It is important to note, however, that some of the data analyzed by the IOM revealed that the level of circulating 25(OH)D in a mother necessary for her milk to confer enough vitamin D to her baby may be associated with other, adverse health outcomes.  More research is needed in this area before a public health recommendation can be made with regard to high-dose supplementation of mothers in order to avoid the need to supplement the baby.

Of course, if a mother has her vitamin D level tested and she’s naturally replete, (a blood level over 50 ng/mL of 25(OH)D, for the purpose of fortifying her milk), her milk is also likely rich in vitamin D and there’s no need to supplement her or her baby.

If a mother has been deficient in vitamin D during her pregnancy, it could take months of supplementation to bring her status to adequacy; meanwhile, her growing baby needs vitamin D for bone health.  Sun exposure, as mentioned above, is how humans were designed to synthesize vitamin D; but sun exposure is a risk few families are willing to take (though it is an option at certain locations and under certain circumstances). Supplementing the baby with 400 IU/day of vitamin D, typically in drop form, is also an option you may wish to choose.  Many pediatricians recommend a “poly” vitamin supplement, but only vitamin D is necessary if you are breastfeeding your baby; ask for a vitamin D-only supplement.  They are widely available – just make sure you know exactly what a dose looks like, because many preparations provide the recommended amount in one single drop.

So, don’t fret, babes!  The vitamin D issue is an easy one to solve, and now you’ve got information to bring to your doctor/pediatrician so you can decide which solution is best for you and your baby!  Relax, enjoy these precious breastfeeding days, and feel confident that your milk is still the very best you can feed your baby.

Diana Cassar-Uhl, IBCLC and La Leche League Leader, has written articles for the La Leche League publications Leaven and Breastfeeding Today, and is the author of the La Leche League tear-off sheet Vitamin D, Your Baby, and You. She is a frequent presenter at breastfeeding education events. Eager to begin work on a Master of Public Health in 2011, Diana hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition. Mother to three breastfed children, Diana has served as a clarinetist on active Army duty in the West Point Band since 1995. She enjoys running, writing, skiing, and cross-stitching if there’s ever any spare time. You can find more of Diana’s work and read her blog, “Normal, like breathing,” at http://DianaIBCLC.com.



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38 Comments | Last revised on 04/08/2011


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38 Responses to Vitamin D and breastmilk … what’s a babe to do?

  1. Jennifer Salowitz says:

    With all due respect, I believe mother’s milk is perfectly formulated. I do believe we have gotten a little too “vitamin obsessed.” I have never given my three children vitamin D drops as infants, though as older toddlers they do start a well-balanced whole-foods multi-vitamin. Not one of my exclusively breastfed babies has ever had issues with vit D and we live in the upper midwest in the USA. I object to giving small babies any supplement, no matter how many studies back it up, unless a blood draw specifically shows a deficiency. You’re right: mother’s milk is a perfect blend.

    • Diana says:

      Thanks for your comment, Jennifer. I totally agree with you. However, vitamin D is not actually a nutrient, it is a pre-hormone, as mentioned here in the article:

      Let’s start with a brief introduction to vitamin D. It sounds like a nutrient, because we call it a “vitamin,” but it’s actually a pre-hormone, which gets converted in our bodies to another substance (1,25(OH)D). The 1,25(OH)D then functions in our bodies to help regulate our blood calcium levels … … In addition to calcium regulation and bone mineralization, vitamin D affects lots of other body systems, most notably our immune function and the cells in our pancreas that affect insulin production and blood sugar metabolism. There is also observational evidence (studies that show a relationship but can’t necessarily prove cause and effect) that vitamin D is associated with such conditions as diabetes, rheumatoid arthritis, multiple sclerosis, prostate, breast, and colon cancers, and respiratory infections/flu, among others.

      In ideal situations, our milk is perfectly formulated; but many in our culture have deviated from the “ideal” and we’re not exposed to the sun like we used to be (some might argue for good reason if they are concerned about sun damage to the skin … but like all health decisions, this one is individual and one person’s risk might be another person’s choice).

      There is also the question of whether our babies SHOULD be getting a full complement of vitamin D from their diet/our milk … we as adults don’t get our daily dose of vitamin D from diet, it is supposed to come from sun exposure. The question becomes, then, whether we are comfortable exposing our babies to the sun, and, if we are, whether the sun where we live actually can act on our skin to trigger the synthesis of vitamin D in our bodies.

      The research shows 15-20 minutes of sun exposure, mostly uncovered (little clothing and NO sunscreen), either south of the 35th parallel or in the summer months in northern latitudes, triggers the production 10,000-20,000 IU of vitamin D in a healthy body (there are other factors that determine “healthy,” BMI <30 is one of them).

      I hope this helps and thanks for your comment.

      • Diana says:

        Only that one paragraph was supposed to be italicized … I do much better with explaining about vitamin D than working in html, obviously. :)

  2. Thank you for this thoughtful and informative article. There is too much wishy-washiness going around about this topic.

    Hannah

  3. Jes says:

    Somewhere in this video(http://www.youtube.com/watch?v=cX-zD8jKne0) Dr Fogelson talks about how delayed cord clamping increases the amount of Vitamin D in neonates – I think I remember him saying it gives them an additional 6 month supply.

  4. Mandy says:

    Very interesting article.
    I have however, breastfed 2 babies in the dark climes of Scotland, where there is supposed to be hardly any sun. I have never given any supplements, maybe I am lucky and naturally high in vitamin D, but neither of them at 6 and 2 are showing any signs of any deficiency.
    Will keep in mind though for any future baby.

    • Diana says:

      Mandy, it’s entirely possible you and your family are perfectly replete in vitamin D, despite your location relative to the equator. Vitamin D levels vary between individuals for many reasons. There is a blood test that can tell your level; however, there is still question in the medical community over what numerical value (as well as other physiological markers) constitutes “sufficiency,” which I mentioned in the article as follows:

      While the Institute of Medicine’s 2010 report on vitamin D intake in the United States and Canada suggests 20 ng/mL as an appropriate level of sufficiency (because it is supportive of bone health, the only outcome that has been proven to have a cause-and-effect relationship with vitamin D), there are other data that recommend 30 or 32 ng/mL as a better measure of vitamin D sufficiency (because the observational outcomes regarding other diseases and vitamin D seem more favorable at this level).

      Likewise, there may be (or there may not be) health conditions that have relationships to vitamin D levels in the body, not just bone health. The AAP makes its recommendation based only on the amount of vitamin D that is known (by data analysis) to support bone health in infants but, like the U.S. gov’t’s Institute of Medicine, still needs more research that vitamin D has any impact on these other health issues. The majority of research that exists now is not based on Randomized, Controlled Trials (there are exceptions), which provide the most conclusive data to prove or disprove the effectiveness of a measure of prevention. I hope this helps and thanks for your comment!

  5. Jennifer Croft says:

    So for thousands of generations have never had to supplement vitamin D and women have been breastfeeding since basically the beginning of time. So even though scientists have facts that doesn’t mean it’s needed. If infants needed more vitamin D then it would naturally already be in our breast-milk!
    Why would we want to mess with what’s already natural. I don’t think it should be recommended for women who are perfectly healthy. I nursed 5 children and they all have high bone density and are healthier then most. My kids haven’t been on any anti-biotics either. So all these scientists and doctors that say all these things in a drug store are safe?? I vote to go the natural way! :)

    • Diana says:

      I am in total agreement with you, Jennifer. I am definitely not one to mess with what’s perfectly natural (which is why I breastfeed in the first place!). The problem is that we, by and large as a culture, HAVE messed with something that is perfectly natural by avoiding sun exposure. In so doing, some of us have depleted our vitamin D levels to the point where our bones are in danger; there are other medical professionals out there who believe bone health is the bare minimum of what vitamin D does in our bodies and there are other “symptoms” of deficiency we are seeing but not recognizing as vitamin D deficiency because they are not bone health related.

      I as an IBCLC definitely do not recommend any medical course for any mother/baby — it’s not in my scope of practice to recommend or prescribe anything. I can, however, share some research on a very controversial topic, which is what I hope I have done here. Keep asking questions, it’s the best way for us to learn!

    • Andrea says:

      Jennifer, I know zilch about your family but I wanted to say, that I would agree more to going “the natural way” if we lived naturally. In this year, 2011, we are so far from natural that we might as well be androids. If your family eats naturally, organic and unprocessed foods, then there’s a much greater chance that your bodies operate the way they are supposed to. But for the rest of us, it is unrealistic to think that our bodies are in any way perfect. We have screwed them up way too much for that.
      Congrats on nursing five children!

    • Annie says:

      Actually, you are partly correct. In norther latitudes, you’ll find that traditional cultures always had animal sources of D such as grassfed butter (let to go rancid, stored in barrels buried in a peat bog), fish livers (again, with the barrel, yuck), various other animal livers, and pork back fat. Also, there’s some research that shows you can increase D levels a lot more effectively with quite small amounts of these animal sources, compared to synthesized vitamins.
      Personally, I’m totally anti-vitamin supplementation… but I think the missing link is the inclusion of high-vitamin foods… especially FAT soluble ones like E, A, and D since we live in such a low-fat society.

    • Megan says:

      If only we lived in a completely natural environment like they did for thousands of years. But becaus sour planet is like a space ship, many things have changed over time. Including life expectancy and quality of life. Thankfully we live in a time of information and the capability to share around the world (like on FB). We cant get a degree in everything in life, so I’m happy for those who take the time to do the research and share it.

      Cheers for breastfeeding and trying to maintain as natural as can be.

  6. Andrea says:

    This is one of the most comprehensive articles I have read regarding vitamin D and breastmilk. Thank you so much for writing.
    It makes me a little sad that so many women, MOTHERS, don’t understand that our bodies aren’t all perfect machines and breastmilk is not “perfect”. It is the best food for your baby but it’s nor is breastfeeding “perfect”. It’s also not necessary to disregard science or medical studies because you are a proponent of breastfeeding.
    The vitamin D issue, as are many things relative to our diet and overall health, aren’t speaking for immediate issues but LONG TERM HEALTH. Most people have poor bone health and that if directly related to their calcium (and vitamin D) intake. It may not show up until a person is 45 and finds they have brittle bones, osteoporosis or are generally fragile and unhealthy. Please, moms, be smart and don’t make decisions without as much true information as possible and picking and choosing who you will take information from.

    • Diana says:

      Thank you, Andrea! You touch on something important in your commment, that vitamin D status can have long-term ramifications. The conditions and diseases that are shown to have an observational relationship to vitamin D status (not yet proven conclusively by randomized, controlled trials, more research is necessary to prove the association) are diseases of “long latency;” that is, they are diseases and conditions that don’t necessarily express themselves until later in life, after years of being “present” but not symptomatic. Whether sufficient vitamin D status (and “sufficiency” is still a controversial condition!) can defer or permanently prevent these diseases from being expressed by a body is yet to be proven … there is much that we don’t know and what seems “fine” today might actually be major health issues a decade or more down the road. That’s what researchers are trying to sort out and prove.

  7. Diana says:

    I’m really thankful for the questions that have been raised here and elsewhere this blog post has been shared! I tried to answer some concerns and elaborate on this topic at my blog. Here is a link to the post … be sure to read “Vitamin D and breastmilk … what’s a babe to do” here first!

    http://dianaibclc.com/2011/04/12/my-thoughts-on-the-vitamin-d-controversy/

  8. Caroline says:

    Thanks for the article! Question: is there a difference between vitamin D2 and vitamin D3? Does it matter which one we give as a supplement to an infant of child?

    • Diana says:

      Hi Caroline,
      Thanks for your question. D2, or ergocalciferol, needs to first be converted in the body to D3, then that gets converted again to the active hormone (1,25(OH)D). Some sources say that extra conversion step (D3, as cholecalciferol, is more immediately used by the body) means less vitamin D is actually available to the body. However, the studies I’ve read say there is little or no difference in how the body responds to either. This is a link I like for this question:
      http://nutrition.about.com/od/therapeuticnutrition1/f/D2orD3.htm

      I hope this helps!

  9. carrie says:

    I battled with this one- didn’t want to expose my babies to anything except breastmilk but living so far north as we do I worry. So we got my baby tested and she was doing just fine in the middle of winter- so they said that it was up to us if we wanted to supplement. The other option apparently was for ME to take supplements (which i’m more comfortable doing) to increase the amount in my brestmilk.

    • Diana says:

      Hi Carrie! Yes, one intent of Dr. Wagner’s research is to communicate that maternal supplementation is a great idea for mothers who want to ensure their milk is conferring the vitamin D their babies need — plus, it makes sure mothers, themselves have all the vitamin D THEY need for optimal health.

  10. Indie says:

    Sunshine, in moderation, is clearly the nature intended way for people to receive an adequate dose of vitamin D. Knowing what we know about the virgin gut of a properly fully breastfed baby it seems that we should be extremely careful in recommending any sort of supplement without clear cause. Also, what research has been done on the possible long term ramifications of bypassing the normal, natural means of vitamin D acquisition and instead using an unnatural one? I have come across one study that found that adults who had been supplemented with vitamin D as infants were more likely to suffer from allergic rhinitis. We’ll not know what other repercussions might be involved until we do further study.

    I personally choose for our family to not supplement with vitamin D. Our pediatrician recommended we supplement but then admitted that she chose sun exposure over supplementation for her own children. Our pediatrician also discussed safer sunscreens as many contain ingredients that are actually carcinogens.

    • Diana says:

      You raise very good points, Indie. I have heard that there is a vitamin D supplement on the market that contains only cholecalciferol and coconut oil, which would theoretically not cause any gut trouble to a breastfed infant … but you are correct that this is a controversial topic that requires critical thinking by each family. What works for one family might not work for another — so it’s great that we are aware of the need for vitamin D and the options we have for obtaining or synthesizing it.

  11. AC says:

    I was surprised to read so many women against supplementing Vitamin D. I am pretty natural myself, but with all the recent research info out about Vitamin D, it is becoming pretty common knowledge that we are short on the Vitamin D – as a people. A few years ago I was visiting a CNM for my exam, and she sent me to the lab to test my Vitamin D level. It was 30. Before the results had even come she put me on 4000IU/day. She upped it to 6000IU/day when the results came. After 30 days of being on 6000IU’s/day I went back to the lab and my levels were found to be 42. I continued on 6000IU/day for another month and retested, and was at 51. I now take 4000IU/day, and my levels remain at about 50-55. I try to test monthly. For me, the test is free, so it is just a simple blood draw. I have 5 children. All of them have been breastfed until they were 3 years old. I am breastfeeding still (he turns one tomorrow!). I have been breastfeeding for 10+ years straight – I have never stopped. I think this is more of a stress on my body than women that start and stop. My children are all close in age. I am glad to have tested my levels, and had a practitioner help me to get my Vitamin D levels up. If you know you have good vitamin D levels there is no reason to supplement your child. But the fact is clear – we do not spend our days outside anymore. We have moved into our houses, and buildings and most of us stay inside. We do not get the sun exposure that we should. Just like if you’re not eating your vegetables like you should, and you do not get the nutrients you need – it is similar when you are not exposing yourself to the sun (and regardless of popular belief, there is such a thing as good sun exposure, and you can do it every day). I do take a vitamin D supplement because I know I do not get the right amount of sunshine (every single day), especially in the winter. I supplement my children in the winter months as well. I have never given my infants vitamin D supplements, and I don’t plan to. I will however, continue to have my own levels checked and make sure my own vitamin D levels are above 50 – hopefully for the rest of my life!

  12. Laura says:

    As a breastfeeding Mother that lives in the Pacific Northwest, I have had concerns about whether my family has an adequate level of Vitamin D, especially my children. Thank you for presenting this information in a way that is easy to understand.

    I have a few questions; first, will my Primary Care Doctor know what I mean if I tell him I want a blood test to check my Vitamin D levels? Is it necessary to also test my nursling? Do my older children (who were also breastfed) need to be supplemented? Is there an advantage or difference to taking a liquid vs. softgel form of Vitamin D?

    Thank you!!

    • Diana says:

      Hi Laura! Thanks for your question. Ask your doctor for a test for 25(OH)D. This is NOT (and I repeat … NOT) the same as the test that measures 1,25(OH)D. That little “1” at the beginning of that test name makes it for something else … the level of converted hormone in your body — a measure of kidney function, NOT your vitamin D store (and this number can vary and is reliant upon other things than your vitamin D stores). I hope that’s clear.

      If you are replete in vitamin D (if your levels are high enough), it is likely your baby is fine, too. Keep in mind that “fine” and “replete” are still controversial among the medical community … there is really no agreement as to what an optimal level of vitamin D is for us as a population, let alone for a lactating mother. Dr. Wagner, et. al’s research report suggests that a mother needs to have a 25(OH)D level of 60 ng/dL in order for her milk to provide all the vitamin D her baby needs, but more research is being done. The IOM currently advises that a level of 20 ng/dL is adequate for bone health. Others suggest 30 or higher is optimal. Talk to your doctor about what he or she knows and what research you’ve done on the topic to decide what level is best for you and how much sunlight or supplement you might need to reach that level.

      As for your older children, talk to your pediatrician about your concerns. He or she might have experience there in the Pacific Northwest that is relevant to your concerns; as well, bring your research and ask specific questions. Vitamin D is necessary for all of us and Dr. Wagner and her colleagues do establish target daily vitamin D intake ranges for older children, by body weight. Your pediatrician will give you a better idea about whether your older children should be tested or supplemented.

      I hope this helps!

      • Diana says:

        OH! I’m sorry that I didn’t answer the part about liquid vs. softgel … I’ve read conflicting claims about how to take the vitamin D — some say it should be D2, others that it should be D3, some say it’s fat soluble so you need it in an oil suspension, others take dry tablets and say it’s fine. I’d recommend calling the supplement companies and see what they tell you about their products, and decide for yourself whether one is more valuable to you than another. Vitamin D is pretty inexpensive no matter how you get it (and it’s FREE if you get it from the sun).

  13. Laura says:

    I agree that, unfortunately, due to changing lifestyle, diet and what we know about skin cancer, that many of us are vitamin d deficient.
    I’ve noticed on some sites that if you mention this some women take it as a personal insult as if you’re saying their milk is not good enough.
    Thank you for this most informative and unbiased article. I will be sharing :)

  14. bridget says:

    It is not that our breast milk is inadequate what it is is that now a days we are getting less sunlight people are staying inside or using excess amounts of sunblock or covering their bodies bc they are worried about skin cancer ect….soooo hence less sunlight equals lower levels of vitamin D…..back even 25-30 yrs ago people stayed outside more often there for most were not worried with the lack of vitamin D, the summers were not as hot or as dangerous therefore people didnt not use excess amounts of sun block….this is why we now need to suppliment our vitamin D unless you spend 20-30 mins a day in direct sunlight with most of your body uncovered and no sun block and mostly around noon.

  15. I’m really thankful for the questions that have been raised here and elsewhere this blog post has been shared! I tried to answer some concerns and elaborate on this topic at my blog. Here is a link to the post … be sure to read “Vitamin D and breastmilk … what’s a babe to do” here first!

    http://dianaibclc.com/2011/04/12/my-thoughts-on-the-vitamin-d-controversy/

  16. Dr Sarah says:

    Diana, what’s bothering me on reading this is… why is it considered such a huge big deal to admit that breastmilk may be anything other than perfect? We know breastmilk is a lot better for our babies than formula. We know about all the good reasons for choosing it. We have science on our side. Why do we act as though dozens of good-quality studies showing its many benefits will all come crashing about our ears if we admit that there may be any respects, however minor and easily remedied, in which it isn’t perfect?

    I don’t believe breastmilk is perfect; I don’t believe anything in this life is perfect. I believe that breastmilk is the healthiest option for babies. Finding out about a possible disadvantage doesn’t shake my faith in all the advantages that I know of. When the science is so firmly on our side, why do we need to act as though our arguments are so fragile that one admission of imperfection will destroy them?

  17. Diana says:

    Thanks for your comment, Sarah. I guess I’m not seeing in this post that it’s a big deal that there is something missing from our milk — only confirming that it IS missing (for many American mothers, and that this isn’t a lie we’re being fed) and that it’s missing because our lifestyles have changed and we no longer spend the time outside we used to spend. This is an issue of concern because formula marketing campaigns (Enfamil comes to my mind immediately) capitalize on this deficiency … I’ve received coupons for Enfamil that show only a cannister of powdered formula and the words “Your baby needs vitamin D.” The fact is that mothers CAN provide all their babies need, but being replete in vitamin D might take a little more active effort than other nutrients. The purpose of this article was to share the most current research about vitamin D and breastfeeding in a manner that allows families to see the whole issue; sun exposure, location of residence, mother’s vitamin D status, and method of infant feeding all weigh into a baby’s vitamin D status, and families deserve to know that they have options of obtaining sun exposure, supplementing mother, supplementing baby, or a combination of the three. I hope this answers your question and I appreciate your comment.

  18. kate says:

    So what I heard was, if my baby gets at least 15-20 minutes of sun a day I dont need to worry about the drops…

    • Diana says:

      Hi Kate,

      It depends on where you are, whether your baby is clothed or otherwise protected, what time of year it is, the color of your baby’s skin … for some, in some places, during some seasons, yes, 15-20 minutes of full-on sun exposure should be adequate, but for many families, that kind of sun exposure is not practical, or they live north of the 35th parallel, or other factors make sun exposure alone unreliable. It’s definitely the ideal route for vitamin D production, just not always possible.

  19. Ayo says:

    Vitamin D may act as a steroid in your body. The supplement is not a vitamin. Google Trevor Marshall and decide for yourself.

  20. Hannah VW says:

    Thanks for this great info.
    I didn’t supplement my 1st baby because of the way my doctor phrased it (“breast milk is deficient in…”).
    However, with my next pregnancy I got tested and my blood levels were around 31: just barely within normal: certainly not ideal for my own health (immune system, cancer risk) and my baby’s.
    Supplementation brought my levels up.

    I really regret not supplementing (myself during 1st pregnancy, or my baby directly) as my son had dental issues and also broke his femur. Hard to say whether or not those were related, but I know Vitamin D is super important to bones and teeth. Live and learn.

  21. Pingback: Lack of Breastfeeding is a Key Factor in Autoimmune & Allergy Pandemic | Best for BabesBest for Babes

  22. Sarah says:

    Interesting! Our new doctor suggested vitamin D drops-I had never even heard of them before. I am not comfortable giving my breastfed 9 month old this…the doctor said it was an optional thing….well then why would I give it to my baby-he doesn’t even need it? Anyway my question is: can’t 15 minutes of healthy sunshine daily give my baby what he needs? We live in Southern California so it’s a rare day that there isn’t sunshine. I prefer to do things all natural when I can and sunshine-in healthy amounts is perfectly safe and something we all need.

  23. renata says:

    I’ve been thinking of this issue for some time. It occurs that formula is a better solution to natural brest-feeding since it has enough vit d! It’s absurd to me. Several years later we will all read new findings and wonder why the previous generations were so poisoned with excess of vit. D. I want to remind that in the past (70’s) in my country babies received vit. C. Now we don’t do it and vit D was given in amounts which now scare pediatricians.

  24. Pingback: The Story | southernbreastfeedingsupport

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