Hello Susan (and all),

First, I'd like to thank you for your outstanding guest post on Nancy  
Mohrbacher's blog on iron supplementation.  I've been sharing it far  
and wide and an so thankful for such a clearly stated, intelligent  
response to the nonsensical AAP recommendation on iron.

Now, I read your question about vitamin D more than 12 hours ago and  
have been itchy to give you some information ever since!  I will  
probably forget something so please feel free to ask me any questions  
you have.  Vitamin D supplementation has been a topic close to my  
heart (or should I say under my skin?  haha) for a few years now, so I  
have become very comfortable with this ongoing study regarding vitamin  
D supplementation in pregnant women:

Here is the link to the study description itself:
http://clinicaltrials.gov/ct2/show/NCT00292591

And here is one "readable" summary of the study and its preliminary  
findings:
http://www.rxlist.com/script/main/art.asp?articlekey=116003

If you "Google around," you will find more by Dr. Carol Wagner, et.  
al.  It is all worth reading, as is the book version (Hale) that was  
released this year: "New Insights Into Vitamin D During Pregnancy,  
Lactation, and Early Infancy."

In short, vitamin D was historically believed to only be necessary for  
bone health.  More recently, researchers are discovering it does a  
whole lot more in our bodies and the intake/blood levels necessary for  
bone health are not adequate for meeting our other needs for vitamin D.
The problem/controversy, which was reflected in the IOM report on  
vitamin D DRI released this week, is that "there is not enough  
conclusive data" to connect intake and blood levels of vitamin D (or,  
conversely, vitamin D deficiency) with the prevention of (or  
development of) these other conditions.

However, what we do have is this:  we, as a population, are avoiding  
the sun, in an effort to prevent skin cancer.  As well, many of us  
live too far north for the sun's rays to be worth a whole lot most of  
the year.  I'll just say that we here in New York could strip down  
naked and go take an afternoon nap in the snow in February and not  
make vitamin D.  However, in July, 20 minutes, mostly uncovered, can  
result in 20,000 - 30,000 IU of vitamin D being produced.  (Or it  
might not, depending on various factors, but that's more than we need  
to discuss right here and now.)  Our levels of circulating 25-OH(D)  
are, in many, many cases, too low to prevent osteomalacia/bone  
loss ... but sometimes, high enough to protect our bones but too low  
to support these "other things" vitamin D is supposed to be involved  
in (but there's "not enough conclusive data" on).

As for being afraid of high levels of vitamin D, it is theoretically  
possible to supplement too much, but according to Wagner et. al. (who  
is citing, I believe Vieth?  I can dig for the reference if you want  
but hopefully I've pointed you in the right direction), doses of  
higher than 10,000 IU/day for extended periods would have to be taken  
in order to approach toxicity.

Babies are being born to mothers who are, themselves deficient in  
vitamin D.  That's why our milk doesn't confer the 400 IU recommended  
for daily intake for infants (which is based on the level necessary to  
prevent rickets).  The work referenced above found that maternal  
supplementation of 4000 IU/day  during pregnancy (which you probably  
recognize as the newly released "upper limit"), followed by 6400 IU/ 
day during lactation (uh oh!  That's more than the government says  
we're supposed to take!!) is necessary to put 400 IU/day into our  
babies, based on average volume of milk consumed, maternal supplement  
amounts corresponding to vitamin D levels in the milk ... it also  
considers that, for a mother's milk to be replete in vitamin D, the  
level of circulating 25-OH(D) in her blood needs to be nearly twice  
the currently accepted (but still debated) target value for  
sufficiency, which is 32 ng/mL (if you google around, you'll note that  
many doctors and others suggest 40 as a minimum, a study of male  
surfers living in Hawaii found that their (unsupplemented) levels  
ranged in the mid-50's to the low 60's ... suggestive that we should  
all be where humans outdoors near the equator are?).  A mother's level  
would need to be >50 in order for her milk to provide the necessary D  
for her baby.

Now, delving a bit further, we learn that it takes months to bring a  
level of vitamin D up in a body.  It could take even longer if the  
body has any absorption issues (known or unknown) or other factors.   
These are months of exclusive breastfeeding (we hope!).  Therefore,  
the recommendation, bearing in mind that most mothers definitely do  
not have the levels of vitamin D in their bodies to adequately fortify  
their milk to meet the needs of their babies, is to supplement the  
babies, beginning within the first few days of birth.

A mother can and should request a vitamin D check; perhaps she's a  
lifeguard in Florida and has enough vitamin D ... she can decide not  
to supplement her baby.  Or perhaps her level is higher than average,  
but not terrific ... that mother may decide to offer a supplement  
every other day or a few times a week, based on what she knows about  
her own body.

As for the supplements themselves, they're available in D-only  
preparations, as drops.  One drop offers the 400 IU.  It can be placed  
on the mother's nipple before baby latches on to nurse, or it can be  
given directly to baby but yes, care must be taken to give only the  
drop, not more because it is so concentrated.  Parents have to request  
the D-only and be counseled to avoid the Tri-Vi or Poly-Vi  
preparations out there, because those contain vitamins that can  
interfere with the absorption of nutrients from mother's milk.   
Doctors who have been prescribing the multi-vitamin preparations and  
are therefore familiar and comfortable with them also need to be  
educated about the D-only supplements.

While I stand to gain absolutely nothing from vitamin D advocacy, I  
have taken it on as a personal mission because I've seen the  
difference it makes in my own life.  My mother, at the time of her  
diagnosis of breast cancer, had an immeasurably low level of 25-OH(D)  
and her oncologist immediately began supplementing her with 50,000 IU  
twice weekly, then once weekly, then bi-weekly, now she takes it once  
a month.  (One connection for which there's "not enough conclusive  
data" is that between vitamin D and breast cancer.  As the daughter of  
a survivor, allow me to state that I'm not taking any chances by  
waiting for a government agency to accept what other studies have  
established.)  Correcting a vitamin D deficiency in my own body has  
been a major part of the improved health and well-being I've  
experienced in 2010 (the other major factor being identification and  
management of a gluten intolerance ... which was contributing to the  
vitamin D deficiency).  I am currently taking, with a doctor's  
approval and monitoring, 7000 IU/day.  My children are 8, 6, and  
(almost) 3; the youngest still nurses 2-3 times a day and I think  
she's the only one who got any vitamin D at all from me.  I didn't  
supplement them as babies at all, because I believed my milk provided  
everything.  Now I understand that my milk does provide everything  
when I'm living as I was created to live ... but I'm clearly not doing  
that!  I'm thankful our bodies adapt and so much does come out fine  
even under less than perfect circumstances (for example, the  
nutritional heft of the milk of a severely malnourished mother is far  
superior to what one might expect ... miraculous!) but I am learning  
that, in the case of vitamin D, a lot of work needs to be done.  I  
believe we (public health we) should be targeting the mothers and  
supplementing us adults, but until the medical profession accepts  
this, we're lagging severely behind and cheating our babies.

I understand I've cited the body of work (please, google to find  
everything, or better yet, find the book) of exactly ONE research  
group, but to me, the studies themselves are so well-done and  
indisputable, I feel very comfortable passing along the information  
that has been reported from them.

I hope this helps and if you have any questions, I'd be delighted to  
try and answer them for you.  Like I mentioned, I've spent nearly 2  
years living with this information and I've experienced firsthand the  
effects of replenishing a vitamin D deficiency, and I'm outraged by  
the IOM report from earlier this week.

Diana Cassar-Uhl, IBCLC and LLLL in upstate NY
(studying for GRE and applying to MPH programs when I'm not being  
mamma, helping mammas, or playing clarinet)

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome