Dr Wight, I appreciate the time you have taken replying to this issue. And
also the time that the ABM put into examining it.

I can't believe that I have spent all of this time corresponding about this
issue of multivitamins with iron for breastfed infants. I know that those
of you on Lactnet will not be the deciding body. But I am disturbed  by the
direction this has taken. And I see daily the effects of the lack of
education in the physicians who are seeing my clients' infants. This is
just one more case, and a big one at that.

>The statement is completely ACCURATE.  Babies make their own Vitamin D from
>sunlight on their own skin.  It is extremely difficult to give mothers enough
>Vitamin D (> 2,000 units per day) to increase the amount in their own
>breastmilk. Having a mother out in the sun will not do it. Human milk was
>never meant to have enough Vit D - babies were meant to make their own.

If mothers do not pass Vit D through their milk, then why would the
shrouded mothers' infants have any greater incidence of rickets?  The
infants and children are not shrouded. Vitamin D levels in human milk can
be measured. It is in the water soluble part instead of the fat soluble.
When my children were infants vitamin supplementing was recommended. My Ped
asked me when they were older if I had given them the vits. I said that I
hadn't. He said, "All the time they were looking for the vit D in the fat
soluble part (where it is in cow's milk) and it wasn't adequte; then they
found it in the water soluble part. Whoever made that stuff must have know
what he was doing."

There are several Pediatricians on this list. I would like to hear from
them as to the incidence of rickets in their patient population. Are all of
the cases of rickets that they have seen dark-skinned or live in dangerous
places where they never go outside the house? Are the cases in fair-skinned
children from environments that prevent their exposure to sunlight?

>I objected for years over the blanket recommendation that all breastfed
>infants receive Vit D.  I felt it was just the AAP being "politically
>correct" (but medically incorrect) by not singling out African-Americans.
>The public health people, however, confirmed that an overall recommendation
>is much more effective.  Rickets is a preventable disease.

This *is* the old American way, isn't it?  Don't educate, just throw a pill
at it. Giving this vitamin cocktail does change the healthful intestinal
flora and integrity of the infant's gut lining. If the AAP really wanted to
enhance the health of those infants that you describe above who get
restricted sunlight, they could put pressure on the drug companies to make
a VIt D supplement. After all they co-operated so beautifully in the
"breastfeeding book" promotion. Maybe the drug companies could see it as
payment for services rendered.

Hey, I just thought of something. One could get a vit D supplement alone at
a natural food store. I'll look into that. Take a 200mg capsule or pill and
give it to those infants who are at risk. Actually, there are vit D
supplements alone at pharmacies.

And if the AAP could get "they whole everyone" to put their infants on
their backs every minute of their lives with the threat of SIDS, I suspect
that they could also, with education,  get them to take their infants
outside at the proper time of the day in order to prevent rickets. (And
even in day care, they could require that they document minutes outside.)
Of course, some parents wouldn't do so, just as some feed their children
nutrient-poor diets and try cover it with a vitamin pill. We have more food
than any people on earth and yet we are malnourished by choice.

I'm trying to look at this rickets issue from a broader
perspective--outside the American myopia. There is something wrong with
this picture. Are we saying that, biologically, all humans are meant to
live within the torrid zones of the earth?  And even then they are not safe
unless they are dark-skinned, because if they do go outside they will die
by the thousands of skin cancer? How did we *get* fair-skinned humans that
didn't have rickets or cancer? Biologically, babies are supposed to thrive
on their mothers' milk. Formula and Tri-Vi-Sol with Iron were not necessary
for health for some time in human history.

Are the only people that are safe from cancer and rickets the dark-skinned
people who live in those torrid zones? Everyone else throughout history
have been plagued by rickets? What about Eskimos? Or other Alaskans? I know
that Rachel Myr has told us that in Scandinavia everyone, young and old,
take cod liver oil. Has this always been available?  If not, did all people
have rickets? Do all peoples in the high and low temperate zones give their
infants supplements to mother's milk?

I know that it is easier to make universal recommendations in public health
rather than educating either the medical people or the public, but it is
also easier to feed formula from the beginning than to overcome the
learning that is sometimes necessary to begin breastfeeding. And with
breastfeeding the mother has to be there for feedings or go to the trouble
to pump and so on. What is easier is not always what is best.

And we know that getting an appropriate amount of sunlight is beneficial to
health in many ways other than just manufacturing Vit D. So educating
people to the benifits of some sunlight each day would enhance overall health.

It is never smart to support ones case by saying, "Well, *I* have never
seen..." But I will say it anyway. I have worked with breastfeeding mothers
for 33 years and have never seen a case of rickets. And I have lived
outside the torrid zone all of the time.

Pat Gima, IBCLC
Milwaukee, Wisconsin











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