Dear all:

I got the inner scoop from an inside source at the CDC on the reality of
the conflicts over sunlight deficiency.  I REFUSE to call it vitamin D
deficiency and had an apoplectic moment when a mom called because her
pediatrician claimed that breast milk was deficient in vitamin D, C, and
A.  The C and A in the TriViSOl are totally unecessary and one drop of the
Trivisol contains TWICE the recommended dose for vitamin D.

So, YES the formula industry is in on this because guess who manufactures
TriViSol.  In the scientific meeting that was held on this issue serious
concerns were raised over the monopoly on the Trivisol and the fact that it
contained twice the dose and two nutrients that were not needed.

Also, the cancer specialists are another piece of the controversy because
they would not allow any recommendations to let infants have sunlight
exposure.

BUT, just so we don't get cavalier, one reason the meeting was called was
from the parents whose infants were affected by rickets - an entirely
preventable and serious disease that can have lifelong consequences. It is
STILL very rare, but is occuring more frequently because of our changes in
environment.

There have been 44 hospitalized cases in Manhattan reported recently in
light skinned infants and another 100+ in darker skinned infants.  It
occurs more frequently in polluted environments and in cities where
sunlight exposure is blocked by tall buildings.  It used to be prevented in
this country back when we all were breastfeeding, by dosing children with
cod liver oil.  Rachel Myr, you might be able to verify that cod liver oil
is still big in Scandanavian countries.  The parents were devastated that
no one had told them that this could occur.

That the report DOES STATE that clinical judgement should be applied to
these recommendations. That rickets is still very rare - and that it is
more frequent in darker skinned infants.  That although darker skin does
decrease the conversion by up to a factor of 6-10 times more, one cannot
simply determine who is at risk based on race alone, especially in cities
such as Manhattan that are highly diverse in ethnicity and nationality and
where there is a fair amount of racial mixing.  That often there are some
precipitating factors limiting sun exposure, expecially among lighter
skinned infants.  That anyone using Trivisol should use it every other day
(even though there has not been any reported harm in the full dose yet - I
do know of cases of vitamin D toxicity and can just imagine widespread use
creating situations where some moms will think more is better).  That cod
liver oil does the same thing (for those of us who are so incensed over the
current monopoly and can't stomach added additional unecessary nutrients to
infants that don't need them).  Finally, I think this might already have
been discussed on Lactnet already, Canada has had recommendations about
vitamin D in place for 10 years with no ill effects on the breastfeeding
relationship.

I think the KEY thing to remember is that we must stress that this is an
environmental problem, NOT a nutritional problem.  Breastmilk is just fine -
it is the change in our environment that is not.  AND using good clinical
judgement ourselves, by providing full information ourselves about the
factors that parents need to consider and how we think it applies to their
specific situation.

My client was very happy with the info I provided her and decided not to
supplement since she spends a lot of time outside (even now with our frigid
weather) and her son hates to be under the stoller shade.

As for politics, I'm thinking some lobbying should be started about this
monopoly situation with the Trivisol.  It is an inappropriate mix and dose.

Best, Susan Burger, MHS, IBCLC, PhD

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