This is a photo of me with my godson – it’s hard to imagine that he may need a supplement. Perhaps he does? I receive lots of emails asking about this topic so the following information may help clarify if you and your children should be tested for deficiency and whether you need a supplement.
Over the past several years there has been much discussion on the topic of vitamin D — it’s importance to health and the ever-growing number of individuals with reportedly low levels. It now seems that everyone from the tiniest newborn to the elderly all reportedly NEED vitamin D supplements. Can this possibly be true?
Professor Michael F. Holick1, the international researcher who first identified the major circulating form of vitamin D, believes that there is a worldwide epidemic of vitamin D insufficiency that is affecting around 1 billion people. He states: “In pregnant women who are following their physicians advice and taking a pre-natal multi-vitamin, calcium supplement and up to 600IU of vitamin D a day, we found that 76% of mums and 81% of newborns are still vitamin D deficient at the time they gave birth”.
For lactating women he recommends 4000-6000IU to satisfy the needs of the infant. “We know now that if children don´t get enough vitamin D then they won’t be able to achieve their genetically pre-programmed maximum bone density and height. Vitamin D deficiency in adults increases the risk of developing breast cancer by as much as 50%, colorectal cancer by as much as 50%, increases the risk of having a heart attack by as much as 50%”1.
It would appear that Vitamin D deficiency is linked to heart disease, diabetes and bone fractures to name just a few of its associated conditions yet there is little mention however of how poor lifestyle choices may contribute to such a deficiency.
Who Needs A Vitamin D Supplement?
If you have always been someone who’s been cautious of getting sunburnt (ie. you have used lots of sunscreen and avoided direct sunlight), if you have cultural or religious habits that require you to cover your face and body, if your diet is limited or you reside in a country far from the equator then YES it does seem that you may in fact be vitamin D deficient and require a high quality vitamin D supplement. For those that haven’t – for those who regularly use safe sun practices sunshine and eat vitamin D rich foods then perhaps you don’t need a daily supplement. As you’ll see with the information I have gathered below the verdict is still unclear.
Katherine Barber, Founder and Director of the African American Breastfeeding Alliance (AABA) and Mishawn Purnell-O’Neal, an independent health consultant and President of the Chicago Chapter of the African American Breastfeeding Alliance, explain2:
“To make enough vitamin D, a baby in a diaper needs a total of only 30 minutes of sunlight a week -less than five minutes a day. Fully clothed and without a hat, a baby would need two hours of sunlight a week, or about 20 minutes a day. Medium to darker skin tones need a little more time in the sun.”
Becky Saenz, a medical doctor and Associate Professor of Family Medicine at the University of Mississippi Medical Center, may help to reassure parents about exposing their babies to the sun WITHOUT sunscreen. She states2:
“There is a vast difference between recommending that it’s okay for baby to sit in the grocery buggy while mom puts the groceries into the car in the early morning or late afternoon, and recommending nude sunbathing at noon.”
Clearly, the best approach is to use common sense – avoid taking your baby out unprotected during the hottest part of the day. Instead, make sure he gets a little sunshine before 10am or after 3pm.
The Debate Continues Across The Globe
It is really tricky for parents to know what to do when the US, the American Academy of Pediatrics3 conservatively (and controversially) recommend that ALL breastfed babies be given vitamin D supplements.
This is because, they say, breast milk does not contain enough vitamin D. (Formula milk is fortified with vitamin D, so this recommendation does not apply to formula-fed infants). Yet at the same time the La Leche League is emphatically opposed to the routine vitamin D supplementation of breastfed infants. An article published on the La Leche League website 4 affirms that vitamin D supplements are not routinely required for full-term, healthy breastfed babies who receive adequate sun exposure, provided the mother is not vitamin D deficient herself. The AAP’s cautious approach is seen by some experts as a “better safe than sorry” type policy.
Routine vitamin D supplementation is also recommended by the Ministry of Social Welfare in Sweden and the Canadian Pediatric Society while in the UK, vitamin D supplements are given only to at-risk babies. This policy is also applied by the National Health and Medical Research Council in Australia and the Ministry of Health in New Zealand offers vitamin D supplements only when a vitamin D deficiency is proven.
The Institute of Medicine (IOM)5 recently assembled a committee of 14 scientists with a broad range of expertise to complete an exhaustive review of scientific literature on vitamin D. In their report they advise that vitamin D deficiency has indeed been OVERESTIMATED, and that most individuals receive adequate amounts through diet and skin exposure to the sun5.They state “A single individual might be deemed deficient or sufficient, depending on the laboratory where the blood is tested. The number of people with vitamin D deficiency in North America may be overestimated because many laboratories appear to be using cut-points (measurements) that are much higher than the committee suggests is appropriate.”6
How Do I Know If My Baby Is Vitamin D Deficient?
Identifying vitamin D deficiency in babies can be tricky because symptoms can be unusual or quite non-specific, such as lethargy, irritability, frequent respiratory infections, seizures, or a failure to grow7. Extreme vitamin D deficiency presents as a bone growing disease called Rickets (most common between the ages of 3-18 months), and involves bowing and deformities of the long bones of the arms and legs, enlargement of the wrists, delayed closure of fontanelles, poor strength and tone, and delayed motor milestones8. Obviously parents do not wish to wait and see if such symptoms will eventuate so the below information may assist you with your decision making process.
So How Much Vitamin D Intake Is Enough?
The Institute of Medicine (IOM)5 recommendations for vitamin D intake (based on an assumption of minimal or no sun exposure) are intended to serve as a guide for good nutrition. Vitamin D is expressed as international units (IU) and more recently in micrograms (µg or mcg)9. The Recommended Daily Allowance (RDA, in IU/d) refers to the intake that covers needs of >97.5% of population5.
- Babies 0-12 months (400 IU/day)
- Children and adults (600 IU/day)
- Elderly over 71 years (800 IU/day)
- Pregnant or lactating women (600 IU/day).
The IOM5 state that “Higher levels…have not been shown to confer greater benefits, and in fact, they have been linked to other health problems, challenging the concept that ‘more is better’.”
Vitamin D boosting foods can easily be obtained from sources such as fatty fish (North Sea salmon, herring, mackerel and sardines), egg yolk, organ meats and fortified food products. Consider the following table which provides specific quantities of vitamin D in these types of food…
Food Sources Of Vitamin D
|Cod liver oil, 1 tablespoon||1360||34.0|
|Fish & Shellfish|
|Pacific oysters, 3.5 oz||640||16.0|
|Salmon. pink, canned, 3 oz||530||13.3|
|Salmon, Atlantic, farmed, cooked, 3.5 oz||360||9.0|
|Mackerel, cooked, 3 1/2 oz||345||8.6|
|Sardines, canned in oil, drained, 3 1/2 oz||270||6.8|
|Tuna, light, canned, 3 1/2 oz||236||5.9|
|Milk, vit D fortified, 8 oz||90-98||2.45|
|Margarine, vitamin D fortified, 1 tablespoon||60||1.5|
|Liver, beef, cooked, 3 1/2 oz||30||0.75|
|Egg yolk, cooked, 1 large||25||0.62|
|Human milk, 1000 mL||20-60||0.5-1.5|
|Yogurt, 1 cup||4||0.10|
|Cheddar cheese, 1 oz||3.5||0.09|
|* Recommended intake is 5 =B5g, or 200 IU (1 =B5g =3D 40 IU) per day.|
If you do feel that you or your baby do require supplemental vitamin D, single-dose drops or multivitamin drops are available. Because many of these products provide the recommended dose in one drop, the AAP and U.S Food and Drug administration recommends that care be taken not to over-administer the number of drops you give to your baby in one sitting11. Bioceutical have a high-strength liquid Vitamin D Forte drop (1 drop =1000IU) and also drops that deliver a smaller dose for babies. Metagenics vitamin D capsules or Dr Vera’s vitamin D tablets are other reliable options.
Adults can assess their current lifestyle choices to gain a clearer idea of how much vitamin D they receive. These following factors can contribute to deficiency10:
Constant cover-up clothing and/or sunscreen (using sunscreen with a sun protection factor of 15 blocks approximately 99% of our skin´s vitamin D production)
- Obesity (obese people show 50% lower blood levels of vitamin D after sun exposure)
- Poor nutrition
- Taking medications (glucocorticoids & anticonvulsants impair vitamin D levels)
- Being homebound
- Exposure to significant air pollution
- Kidney or liver disease
- Ageing (older age reduces our skin´s ability to synthesis vitamin D from the sun)
- Living far from the equator
- Having darkly pigmented skin
- Reductions in sunlight during winter
Minimising toxic chemicals that can contribute to vitamin D deficiency (smoking, medications, pollution) will also make a massive difference. By reassessing your health choices you will find an abundance of possibilities for improving not only your vitamin D levels, but your overall health.
We can make valuable changes to the habits we have and the choices we make! With sensible sun exposure and a nourishing diet you may be able to meet most of your vitamin D requirements and perhaps only need a supplement intermittently.
Again if you do feel that you do require supplemental vitamin D, single-dose drops or multivitamin drops are available as well as capsules. Try to source a high quality brand, one that does not have added chemicals and artificial flavours. The AAP and U.S Food and Drug administration recommends that care be taken not to over-administer the number of drops or capsules that you have. 11 Bioceutical have a high-strength liquid Vitamin D Forte drop (1 drop =1000IU) and also drops that deliver a smaller dose for babies. Metagenics vitamin D capsules or Dr Vera’s vitamin D tablets are other reliable options.
In closing with sensible sun exposure and a nourishing diet adults may be able to meet most of their vitamin D requirements and perhaps only need a supplement intermittently. If however you intuitively feel that you would benefit from a regular vitamin D supplement then trust this and speak to your health care provider.
If your diet and lifestyle has been poor for a number of years then a regular supplement for a period of time may be extremely beneficial but remember to move towards a healthier lifestyle and intermittent supplement programs.
Some parents have concerns about giving their newborn supplements and to answer the question – Do all newborn babies need to take regular vitamin D supplements?
Honestly I do not know. If parents have hesitations then I suggest they assess their current and previous lifestyles, have their own individual vitamin D levels tested and gather further information. If you decide that you would like to supplement vitamin D for a period of time then I would also urge you to source the highest quality brand possible with the fewest additives and remember to relax and ENJOY this time with your beautiful newborn.
Barber K, Purnell-O’Neal M. The Politics of Vitamin D: Questioning Universal Supplementation 2003; March/April 117.
Armstrong C. Practice Guidelines AAP Doubles Recommended Vitamin D Intake in Children. Am Fam Physician 2009 Jul 15; 80(2):196-198.
Mojab CG. Sunlight Deficiency: Helping Breastfeeding Mothers Find the Facts. Leaven 2003; 39(4): 75-79.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. J ClinEndocrinol Metab 2011; 96: 53–58.
Dietary Reference Intakes for Calcium and Vitamin D
Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics 2008; 122:1142–1152.
Pettifor, JM, Prentice A. The role of vitamin D in paediatric bone health. Best Practice & Research Clinical Endocrinology & Metabolism 2011; 25:573–584.
Lamberg-Allardt C. Review Vitamin D in foods and as supplements Progress in Biophysics and Molecular Biology 2006;92:33–38.
Lee JH, O’Keefe JH, Bell D, Hensrud DD, MD, Holick MF. Vitamin D Deficiency An Important, Common, and Easily Treatable Cardiovascular Risk Factor?Journal of the American College of Cardiology 2008; 52(24): 1949-1956.
Abrams SA. What Are the Risks and Benefits to Increasing Dietary Bone Minerals and Vitamin D Intake in Infants and Small Children? Annu. Rev. Nutr. 2011; 31:285–97.