I'm still trying to get caught up on inquiries and Lactnet posts related to
vitamin D. Regarding the AAP's recommendation to supplement all breastfed
babies with vitamin D, Marsha Walker asked on April 9, 2003:
"Were the babies' lead levels checked? Can't high lead levels impair
vitamin D metabolism?"
My answer: Lead exposure has been shown to impair vitamin D metabolism,
which is why I included it in my list of risk factors for vitamin D
deficiency in my publications on vitamin D and breastfeeding. However, I
have yet to see a rickets/vitamin D deficiency-related case study or a
study of cases at a particular hospital, etc., report on lead levels. Lead
exposure doesn't seem to have been on anyone's radar screen in regard to
breastfeeding and vitamin D deficiency. With the exception of my own work,
I have not seen *any* publication discussing lead exposure in the context
of vitamin D deficiency and breastfeeding. Given that people with darker
skin commonly have less choice than the dominant light-skinned majority
over whether they can live in environmentally safe housing in
environmentally safe neighborhoods, I do indeed wonder what we would find
if we started tracking lead exposure in dark-skinned infants living in
inner cities who develop rickets.
"What about genetic predisposition to rickets? Is some of this genetic in
nature?"
My answer: Yes, genetic conditions can result in impaired organ function
which can interfere with the metabolism of vitamin D. Generally speaking,
the studies that I have read appear to try to make clear whether such
conditions are or are not involved.
"Most of the reports of rickets are case studies and anecdotal reports.
Where are the population based studies that confirm who is at risk and who
is not?"
My answer: In the US, we do not yet have information available from such
population based studies. Rickets has not been a reportable disease.
"Since when did limited exposure of young babies to sunlight cause skin
cancer? We aren't talking about the leather-faced old ladies who bake on
the beaches for hours every day. Where is the evidence from the American
Cancer Society that babies cannot be taken out in the sun for a few minutes
a day?"
My answer: I have not yet found any research examining whether minimal
levels of sun exposure just adequate for the endogenous production of
vitamin D increase the risk of skin cancer. I think that it is highly
unlikely that such research will ever be conducted (in the US at least)
given the prevailing views of the AAP and other national health agencies on
sun exposure.
"What are mothers supposed to do? Keep them inside for 6 months and then
slather them with chemicals? Will mothers also be informed that high levels
of vitamin D can be toxic? What happens if mothers secretly sneak their
babies out into the sun for a walk?"
My answer: I hope that my article, "Sunlight Deficiency: A Review of the
Literature," will help those who read it understand the options for
ensuring that breastfed children maintain adequate levels of vitamin D. Its
full text can be read from the publications page and vitamin D page of my
website.
"Mead Johnson has anticipated this news by making sure all of its discharge
bags have a coupon for its vitamin D preparation... One wonders how much
lobbying they did behind the scenes to cash in on this windfall of new
customers."
My answer: I wonder, too. Its unlikely that much money will be made off of
supplements directly. But the conversion of women from breastfeeding to
formula feeding in part or in full due to supplement marketing in violation
of the spirit or word of the WHO Code would yield a sizable profit.
"What about other sources of supplementation? Who will be conducting safety
studies on the side effects of this supplementation? I think it will take
more than a letter from breastfeeding advocates to change this policy. I
think we need a whole lot better research on this topic and that this
recommendation has been rendered in haste.
My answer: To my knowledge, no one has conducted research examining whether
vitamin D supplementation has any negative physiologic effects. We also
don't know how recommendations of supplementation affect maternal and other
caregiver attitudes and behaviors regarding breastfeeding. Much more
research is definitely needed.
References:
Good Mojab, C. Sunlight deficiency: A review of the literature. Mothering.
March-April 2003; 117:52-55; 57-63. Available online via:
http://home.attbi.com/~ammawell
Good Mojab, C. Sunlight deficiency and breastfeeding. Breastfeeding
Abstracts. 2002; 22(1):3-4. Available online via:
http://home.attbi.com/~ammawell
My apologies on the delay in my reply,
Cynthia
Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC
Ammawell
Email: [log in to unmask]
Web site: http://home.attbi.com/~ammawell
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