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From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 24 Aug 2000 10:41:23 +0200
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I have said this before, more than once, so skip to the next post if you are
weary of reading about fish fat, a culture-specific nutritional bonanza.
'In Scandinavian countries (with it's very high bf rates, eg 99% at birth
and
40% at 12 months in Norway), vit d drups (I've heard they actually give a
fish oil solution) are given out free by government to every nursing
mother.' (Bon)
Wish I knew where to send people to sign up-- as far as I know you have to
buy the stuff yourself here in Norway, but it is within the reach of
virtually everyone.

The Norwegian State Council on Nutrition here continues to recommend that
ALL persons, breastfed or not, fair or swarthy to whatever degree, take one
teaspoon of cod liver oil daily, from age 6 weeks until the end of life.
This is the only dietary supplement officially recommended, for anyone.  It
provides 10 micrograms of vitamin D in a readily bioavailable form with
virtually no risk of toxicity at the doses recommended.  The cod liver oil
is so refined that it seems to pose no allergenic risk to infants.  It has
added vitamin E as an antioxidant but will taste rancid if kept too long.
More incentive to take it regularly and keep a fresh supply!  If babies spit
it up, it will stain clothes (yellow) and it smells undeniably fishy.
Still, most babies seem to like taking it.

'You mostly find rickets today in northern countries/latitudes with
immigrant populations that don't go outside, or are completely covered when
outside.' (Dettwyler)
Right, and this is what we see, folks.  But cod liver oil has other benefits
besides preventing rickets in vulnerable groups.  Read on.

Mimi asked:
1. What is the bioavailabilty of Vitamin D in breastmilk?  My understanding
that like other substances in breastmilk (iron), the levels may be "low" but
one must also take into account the bioavailability may be greater than with
other sources (eg cow milk formula).
Yes, Mimi.  And most of the vitamin D in breastmilk turns out to be in the
aqueous portion, in a sulfate form.  It is very available to the baby but
seems to be insufficient without daylight exposure in addition.

2.  What impact does maternal prenatal vitamins have on Vitamin D levels in
milk?  I advise the mother's in my practice to continue with their prenatal
vitamins while they are nursing..
Supplementation to the mother will ensure that milk levels are present, and
ensure that mother gets enough for her own needs.  Overdosing mother will
not lead to greatly increased amounts in milk, and indeed, in pregnancy,
overdosing the mother can harm the baby.  There is a biologic mechanism to
prevent overdosing through breast milk, and it may be from a time when we
all got enough daylight exposure.  Since most of us live indoors now and
wear clothes outside, this biological mechanism may not be as helpful as it
was many thousands of years ago.  Luckily we have the ability to reason, and
I believe that whoever endowed us with reason also wanted us to use it.

Pat Gima asked: What is the medium in which those vitamins are delivered?
I don't know what the synthetic preparations are dissolved or suspended in.
Cod liver oil is the oil rendered from the liver of codfish.  It is high in
polyunsaturated fatty acids (cod have to be supple enough to swim in arctic
waters so the saturation levels of mutton or coconut fat would not be very
adaptive), with about a gram of omega-3 fatty acids per teaspoon, including
the magical DHA now being added to artificial baby milks in some places.
Cod liver oil also contains Vitamin A, 500 micrograms per teaspoon.  It is
available pure and unadulterated aside from the antioxidant vitamin E.

For Norway, where access to sun is more limited and much of the country is
daylight deprived all winter, and where the only domestic crops historically
supplying vitamin A were carrots and rutabagas, cod liver oil has been
literally a godsend.  The old-fashioned recommendation was to take cod liver
oil in all the months with 'r' in the name-- September to April, which by
many of your standards is wintertime in much of our country.  I find it
easier never to stop taking it and I don't know anyone who takes it for its
delightful flavor.  You can buy easy to swallow capsules containing the same
doses of vitamins and a gram of omega-3 but it is concentrated from other
kinds of fish liver and I am more of a purist than that.  Also more of a
cheapskate-- they cost a lot more than the oil.

With the modern availability of fresh vegetables, vitamin A is not as great
a problem in wealthy countries.  Vitamin A deficiency is still the leading
cause of blindness in developing countries, with infants especially
vulnerable.   Cod liver oil appears to be one of those aspects of Nordic
life that has contributed to the generally good health and longevity of the
population for many generations.  There is even a northern Norwegian
delicacy, now enjoyed only by hard core cultural preservationists,
consisting of freshly cooked cod livers, eaten with flatbread.  I have
witnessed this, and find a teaspoon of cod liver oil is aesthetically more
acceptable.

Remember, the reason most Americans don't need added vitamin D is that they
have it added artificially to the milk they drink, not because they have
natural dietary sources. It is not a natural component in cow's milk either.
Artificial feeders don't need to think about supplementing Vitamin D because
the factory does it for them.  But most milk here is unfortified so we need
to keep the natural source in our diets.

For the record: I still own no stock in the cod liver oil company and have
not been paid to post this.  Skoal!

Rachel Myr
Kristiansand, Norway

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