Thursday, September 29, 2011

The elusive vitamin D

I've been thinking a lot about vitamin D lately. A couple of people I know, whom I assume spend tons of time frolicking outdoors, were tested and found to be deficient. How could this be?, I wondered. I started reading a bit about it here and there, and found it to be a really confusing topic. There seem to be two conflicting viewpoints going around: a) that it is easy to get enough vitamin D from the casual sun exposure in all climes, or b) that most people are deficient in vitamin D, and universal supplementation is recommended. Surely, only one of these can be right! But how to tell which one? Or is there a magic solution somewhere in between the extremes?

The UK Departments of Health recommend that all pregnant and breastfeeding women and all children, ages 6 months to 5 years (unless drinking 500mL of fortified formula a day--regular milk isn't fortified in the UK), take a daily vitamin D supplement. While they say that regular sun exposure is adequate for most people, there have also been studies that found that more than half the adult population of the UK is vitamin D deficient, especially in the winter and spring. So not only is this confusing, you also have to keep in mind what the aim of recommendations like those from the DH are when trying to apply it to your own situation. Oh, public health, how I both love you and get annoyed by you at the same time! These recommendations are for populations. The DH knows that it is both safer and cheaper to recommend that everyone, or at least all people in "at risk" groups, take supplementation than that a small minority of those people end up with diseases like rickets and poor bone health. What the DH does not know is whether I, personally, or my family are actually deficient in vitamin D and could benefit from supplementation. So while it is useful to consider the official advice, it doesn't tell me the whole story.

Gus soaking up some rays in the back garden
Today I read this post over on Best for Babes (and this follow-up on the author's own blog) and found it really useful. It is still obviously talking about populations, but at least it is providing me with context, not just a one-size-fits-all approach. There's a bit of a philosophical debate within breastfeeding circles regarding vitamin D. If breastmilk is complete nutrition for your baby, providing everything baby needs for at least the first 6 months of life (which I believe it is!), then why should we need to give vitamin D supplements? Is it somehow betraying breastfeeding to suggest that vitamin D supplementation can be useful, or even necessary? The author, Diana Cassar-Uhl, looks extensively at the research surrounding vitamin D deficiency, sufficiency, and supplementation. All extremely useful; just what I was looking for. In particular, she reports that studies show that it is very hard for our bodies to make enough vitamin D from the sun at higher latitudes (i.e. where the UK is), especially in the winter months. But the thing that really helped me wrap my head around the issue of giving vitamin supplements to babies was this: if older children and adults only get 10% of the necessary vitamin D from our diet, why should we expect infants to have 100% of the need met through diet alone (breastmilk)? It is probably possible for a baby to get it all through breastmilk, if the mother's stores are high enough, but is it necessary? I don't know the "right" answer to that question, but, to me and for my family, I would say it is not. There are other sources, i.e. sun exposure and vitamin supplementation, that can play their part.

Way back in the day, people would have gotten enough vitamin D through sun exposure, as they would spend hours outside everyday working in the fields, washing laundry at the creek, etc, etc. But for me, that is simply not possible. So I am going to try to get it in whatever way I can. I try to take Gus outside for an hour every day when the weather is nice. (Of course, this opens up the whole question of what is the optimal amount of time to go without sunscreen or other protection from the sun--most sources seem to say between 15 and 30 minutes. Especially since Gus is so fair compared to my own complexion! I have never had to worry about sunburn for myself, but I don't want risk him burning.) To make up the difference between what we can synthesize from the sun and what we need, especially in the winter--and, often, rainy summer!--months, I am going to give Gus vitamin D drops. (There is already vitamin D in the daily multivitamin I [try to] take since I am breastfeeding.) I don't have any problem giving these to Gus, since he is already eating solid foods--especially if I can get the kind with no sugars, flavourings, colors, etc, which don't appear to be available in the UK. But, no worries, I've got connections ;)  When we have another baby in the future (God willing!), I think I will try to get my own levels tested and then take enough supplements myself to provide a sufficient amount to the baby, so I wouldn't have to give drops before 6 months, if possible. Jon takes a multivitamin, but it doesn't seem to have vitamin D in it, so I should probably look into a separate supplement for him as well, especially since he sees the least amount of sun out of all of us!

I am really glad I have come to a conclusion regarding this issue. I was pretty sure I was going to give Gus the drops anyway, but now I feel I really understand why it is a good idea for us. What about you--do you supplement? Why or why not?


  1. Thanks for this post! I've seen so many "Vitamin D is of the devil" and "If you don't give your child vitamin D you are a sucky parent" posts that it's overwhelming! Joe's pediatrician recommended Vitamin D for Joe; I just haven't gotten around to getting it!

  2. Yes, now that I have done all the work of making the decision, now I have to actually remember to purchase and subsequently give the drops--might be the hardest part ;)

  3. I actually know several people in LA who work outside, in a sunny enough part of the country, and were VERY deficient in Vit. D. They were each told by different doctors that their bodies do not process Vitamin D and sunlight like everyone assumes. Just a tidbit from a very sunny warm area of the world. No idea my own Vitamin D levels, but my hair does have sun highlights since I moved.- Julie

  4. I've really been going back and forth on this, so I'm glad you posted! I can't wait to go read the links.

    Before I had just made sure we got outside for at least a little bit each day (easy enough when you're walking a dog) and haven't worried about sunscreen (since apparently it can be a bit controversial as well). However, our (very crunchy, very pro-breastfeeding) doctor has really stressed the need for both Miriam and me to take vitamin D. "To get enough vitamin D you would need to sit outside in the sun for 50 minutes at noon with 60% of your body exposed. Every day." That's her line.

    She recommended a single drop that you put on your breast before nursing for Miriam. Carlson Baby D drops, which you can get on Amazon. She also recommended something like 1000-2000 units for me (but no more than that), even though normal prenatal vitamins only have 400 (which is 100%).

    All that to say I'm leaning towards it, but haven't gotten around to it. :)

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