More doubts about D vit supplements

[micky]

These things makes me uneasy:

1 Vitamin D supplement contain saccharine. Pregnant women are told to avoid artificial sweeteners if possible because the effects on the fetus are not well-known. Yet we are encouraged to give our newborns saccharine DIRECTLY. When elsewhere I again read that kids should not consume it because it can lead to 'brain overstimulation' (see british weaning publication).

2 The dose. Take Jekovit. It is 3-5 drops for EVERYBODY. Disregarding the weight?? Surely it must play a part. More disturbing even is the fact that also pregnant women taking Jekovit should not exceed the 5 drops (now they are a bit heavier and bigger that a newborn). Am I giving my child the same dose as an adult??? 10 micrograms that is

3 Why is it assumed that all kids are vitamin D deficient? Summary of arguments (excuse the breastfeeding focus from my experince)

A I breastfeed. I was told there is NO vitamin D in human milk. Bless them. CORRECTION. There is some. Not enough, I concede, cause nature assumed babies would get enough sun exposure. Of course nowadays there are other concerns and environmental changes that make this option less desirable. So be it. Not enough. However the amount of D vit in human milk depends on the mother's status of vitamin D. So much so that they are thinking that supplementing the mother might be safer than supplementing the kids.

B There is not enough sunshine for kids in Finland. With all due respect: do they seriously think that in places like Italy all babies under 6 months regularly sunbathe ??? Of course they are never under direct sun, same as here. Yet there is no supplementation in Italy. Case of irresponsibility? Beyond 6 months, I would have thought that winter only would be a problem in Finland. Given that in summer, as my mother commented, there is more sunshine than in Venice.

Now don't get me wrong. I'm torn. I certainly don't want to harm my daugther by not giving her enough D vitamin. But also the opposite is true. I must admit, I don't believe in one-size-fit-all supplementation or practices in general. Yes, it is cheaper. But it's not uncommon for these practices to be revealed to be unnecessary or even dangerous after a certain time.

So despite this frame of mind I continue to give some D vit. With serious doubts. Does anybody share my concern? Can anybody offer more enlightening information?

[scoobymcdoo]

I seem to remember posting the same topic about 6 months ago!

bb/viewtopic.php?t=11460

I agree with you about other countries not giving Vit D- in the far north of Scotland where the MIL works as a pharamcist (and there is 6 hours of daylight in the winter), she has never sold Vit D supplements.

I gave Vit D to Sophie a few times per week over the winter and since March I have lost the bottle- she stays covered up outside (if she wears her hat- another story), but I am still not worried about her need for extra Vit D. She has it in her milk and her diet is very good.

Hannah

[raumagal]

These things makes me uneasy:

3 Why is it assumed that all kids are vitamin D deficient? Summary of arguments (excuse the breastfeeding focus from my experince)

A I breastfeed. I was told there is NO vitamin D in human milk. Bless them. CORRECTION. There is some. Not enough, I concede, cause nature assumed babies would get enough sun exposure. Of course nowadays there are other concerns and environmental changes that make this option less desirable. So be it. Not enough. However the amount of D vit in human milk depends on the mother's status of vitamin D. So much so that they are thinking that supplementing the mother might be safer than supplementing the kids.

B There is not enough sunshine for kids in Finland. With all due respect: do they seriously think that in places like Italy all babies under 6 months regularly sunbathe ??? Of course they are never under direct sun, same as here. Yet there is no supplementation in Italy. Case of irresponsibility? Beyond 6 months, I would have thought that winter only would be a problem in Finland. Given that in summer, as my mother commented, there is more sunshine than in Venice.

Now don't get me wrong. I'm torn. I certainly don't want to harm my daugther by not giving her enough D vitamin. But also the opposite is true. I must admit, I don't believe in one-size-fit-all supplementation or practices in general. Yes, it is cheaper. But it's not uncommon for these practices to be revealed to be unnecessary or even dangerous after a certain time.


?

It is recommended that moms breastfeed for at least 12 months and for as long thereafter as the mother and infant desire. However, human milk even though it may contain some Vitamin D it does not contain enough vitamin D to prevent rickets in children. Sunlight is the usual source of vitamin D production in the skin. While some countries have enough sunlight so babies are exposed (doesn't mean sunbathing) enough to get the required amount of Vitamin D, in norther countries they don't get enough sunlight for any baby to get the required amount anyway. In addition, sunlight exposure is difficult to measure anyway. Factors such as the amount of pigment in your baby’s skin and skin exposure affect how much vitamin D is produced by your body from sunlight. Exposing infants and children’s skin to sunlight has been shown to increase the risk for skin cancer later in life anyway and is NOT recommended to get the necessary Vitamin D. Therefore, the safer alternative to ensure babies get enough is to use the Vitamin D drops or getting the Vitamin D via formula.

But anyway, breastmilk doesn't contain enough Vitamin D to prevent rickets. Vitamin D promotes the body's absorption of calcium, which is essential for the normal development and maintenance of healthy teeth and bones. Calcium is also important to nerve cells, including the brain. Rickets is a disease of the bones and is difficult to diagnose clinically without an X-ray before your infant begins to walk, at which time there will be excessive bowing of the legs. There may also be swelling of the wrists and ankles. Many infants with vitamin D deficiency will have slow growth. Some may have breathing and heart problems.

I know people who haven't given the Vitamin D with no problems but it could be their kids were exposed to enough sunlight or they had formula. It's really hard to tell.

They recommend Vitamin D drops for the reason that they don't want kids to be in the sun (due to the risk of skin cancer later in life) and because breastfeeding just doesn't give enough Vitamin D. I don't know what kind of healthcare they have in the southern european countries you mentioned but in Finland they have one of the lowest infant mortality rates in the world for example (Finland is about 3.8/1000 live births while Italy is 6.3/1000). In my experience they have a high level of care especially for children and infants. I don't think the recommendations are frivolous.

If many infants are formula fed for example they don't need the Vitamin D drops (because it is contained in the formula). If many babies get formula the use of Vitamin D drops may not be widespread. In the United States they also recommend Vitamin D drops now as well (all year round, Northern or Southern parts) at a minimum level 200 IU of vitamin D per day beginning during the first 2 months of life and continuing throughout adolescence. When kids are older they can get Vitamin D from fortified milk or milk products, fatty fish or eggs for example. Infants only get breastmilk and studies have shown that infant exposure to sun has been decreasing in recent years (due to information about the risk of skin cancer) so more kids have Vitamin D deficiencies now.

Overdoses of Vitamin D are very, very rare. It is much more common to have a vitamin D deficiency. The body has a huge capacity for storing Vitamin D and with normal doses there is so little that an overdose wouldn't occur.

However, excessive doses of vitamin D can result in increased calcium absorption from the intestinal tract. This may cause increased calcium resorption from the bones, leading to elevated levels of calcium in the blood. Elevated blood calcium may then cause calcium deposition in soft tissues such as the heart and lungs. This can reduce their ability to function. Kidney stones, vomiting, and muscle weakness may also occur due to the ingestion of too much vitamin D.

Regarding your question about dosage, in the US the recommendations are as follows (for all sources of Vitamin D including foods):

infants 7.5-10 micrograms (or 300-400 units which is the old unit of measurement)
10 micrograms for children 4-10 years old
5-10 for adolescents and adults
10 for pregnant and breastfeeding women

[micky]

Thanx for your replies. Thanx to raumagal for your detailed message. I did not mean to start another debate pro/con supplementation. My personal scepticism reflects in the extent point 3 became the focus of my post. That was not my intent though. I got carried away. I am aware of the arguments pro supplementation. I personally feel I lack the data to support a choice either way, but I continue to give the supplement.

My aim was to find out more about the use of SACCHARINE in child preparations. And why the weight does not affect the dosage.

By sunbathing I meant direct sun exposure. I just doubt that in most countries a caucasian infant under 6 months gets the 17.1 minutes of daily direct sun exposure (with only head and hands uncovered) necessary to maintain a good vitamin D level. Far from advocating direct sun exposure, just wondering how much difference there is in practice between Finland and other countries.

[raumagal]

[quote="micky"]
My aim was to find out more about the use of SACCHARINE in child preparations. And why the weight does not affect the dosage.
quote]

I think that they say Saccharine is not metabolized and if large amounts are ingested it can accumulate in the baby's bladder during pregnancy (the fetus can't get rid of it at the same level as the mom which can cause problems). For children with diabetes they say it's ok to use saccharine for example because their bodies have the ability to remove the ingested amounts.

I would think that probably the amounts in the Vitamin D drops are quite small? Perhaps saccharine is not seen as a problem because those levels are easily passed through a child's system (don't accumulate in the bladder)? That's just speculation though - maybe you could ask your doctor?

But don't they have drops without saccharine?

[elizestrada]

Cod liver oil is great source of Vitamin D.

[efx]

well, it's time to send something

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Indian Pediatr. 2006 Mar;43(3):247-51.
Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants.

Balasubramanian S, Shivbalan S, Kumar PS.

Kanchi Kamakoti Childs Trust Hospital (KKCTH), 12- A, Nageswara Road, Nungambakkam, Chennai 600 034. Tamil Nadu, India. sbsped53@sify.com

This report is based on observations during the conduct of a study of hypocalcemia in infants and children. In a study of 50 cases, 13 exclusively breast fed infants manifesting with hypocalcemic seizures were confirmed to have vitamin D deficiency. None of the 13 infants had received vitamin D supplementation. All of them had biochemical evidence of hyperparathyroidism and low levels of 25 (OH) Vit D3 and promptly responded to therapy with vitamin D and calcium. All the mothers of these 13 infants had low levels of 25 (OH) Vit D3. Mothers of 5 infants had reported reduced exposure to sunlight due to religious reasons. This report emphasizes the need to supplement Vitamin D in exclusively breast fed infants and also to encourage exposure to sunlight in them and their mothers.

PMID: 16585820 [PubMed - indexed for MEDLINE]

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Issues in establishing vitamin D recommendations for infants and children.

Greer FR.

Department of Pediatrics, University of Wisconsin Medical School, Madison, WI, USA. frgreer@wisc.edu

In 1963, the American Academy of Pediatrics Committee on Nutrition recommended 400 IU of vitamin D per day for all infants and children. After the late 1970s, this became an inconsistent recommendation, particularly for breast-feeding infants. In 2003, however, the Committee on Nutrition of the American Academy of Pediatrics recommended 200 IU/d vitamin D for all infants and children. This was in response to the vitamin D adequate intake recommendations made by the Institute of Medicine in 1997, the increasing number of reports of nutritional rickets in certain populations of American infants, and the Healthy People 2010 goal of having 75% of infants breast-fed for the first 6 mo of life. In making these recommendations, many issues were taken into consideration, including the following. 1) Vitamin D deficiency is more than rickets, which is the final stage of the deficient state among growing children. 2) Adequate sunlight exposure cannot be determined exactly for every subject. 3) There is new awareness of the hazards of ultraviolet-B light exposure in childhood and the subsequent development of skin cancer in adulthood. 4) There is decreasing intake of vitamin D-fortified foods among older children and adolescents. More research is needed in the pediatric population to determine the recommended dietary allowance of vitamin D. A new definition of vitamin D deficiency that would make use of normal serum concentrations of 25-hydroxyvitamin D3 in a given population is needed. The recommended intake of 200 IU/d may not be enough. More data are needed to support the adequacy of the present and possibly even higher recommended vitamin D daily intakes.

PMID: 15585801 [PubMed - indexed for MEDLINE]

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Arch Pediatr. 2005 Dec;12S3:S145-S165. Epub 2005 Nov 21

[Article in French]

Breast feeding: health benefits for child and mother.
Turck D; Comite de nutrition de la Societe francaise de pediatrie.

Unite de gastroenterologie, hepatologie et nutrition, CHRU de Lille, hopital Jeanne-de-Flandre, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.

Breast milk contains hormones, growth factors, cytokines, cells, etc., and offers many advantages over cow's milk or soy protein infant formulae. The composition of breast milk is influenced by gestational and postnatal age. Prevalence of breastfeeding in France is one of the lowest in Europe: in 2003, only 58% of infants were breastfed when leaving the maternity ward, for a median duration of 10 weeks. Breastfeeding allows normal growth until at least 6 months of age, and can be prolonged until the age of 2 years or more, provided that complementary feeding is started after 6 months. Breastfeeding is associated with slightly enhanced performance on tests of cognitive development. Exclusive breastfeeding for at least 3 months is associated with a lower incidence and severity of diarrhoea, otitis media and respiratory infection. Exclusive breastfeeding for at least 6 months is associated with a lower incidence of allergic disease in at-risk infants (infants with at least one first-degree relative presenting with allergy). Breastfeeding is also associated with a lower incidence of obesity during childhood and adolescence, as well as with a lower incidence of hypertension and hypercholesterolemia in adulthood. Maternal infection with hepatitis B and C virus is not a contraindication to breastfeeding, as opposed to HIV infection and galactosemia. A supplementation with vitamin D and K is necessary in the breastfed infant. Very few medications contraindicate breastfeeding. Premature babies can be breastfed and/or receive mother's milk and/or bank milk, provided they receive energy, protein and mineral supplements. Return to prepregnancy weight is earlier in breastfeeding mothers. Breastfeeding is also associated with a decreased risk of breast and ovarian cancer in the premenopausal period, and of hip fractures and osteoporosis in the postmenopausal period.

PMID: 16300936 [PubMed - as supplied by publisher]

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and, oh yeah

Int J Vitam Nutr Res. 2004 Jan;74(1):27-34.

Use of vitamin D and other dietary supplements by Finnish children at the age of 2 and 3 years.

Marjamaki L, Rasanen M, Uusitalo L, Ahonen S, Veijola R, Knip M, Virtanen SM.

Tampere School of Public Health, 33014 University of Tampere, Finland. liisa.marjamaki@satshp.fi

The aims of this study were to investigate the frequency of the use of vitamin D and other dietary supplements by Finnish children at the age of 2 and 3 years, to evaluate daily nutrient intake from supplements, and to investigate the relation between supplement use and various sociodemographic factors. The families of 534 newborn infants were invited to a birth cohort study in 1996-1997. Families of 292 children at the child's age of 2 years and families of 263 children at the age of 3 years completed a three-day food record from which the daily use of dietary supplements was calculated. The frequency of dietary supplement use was 50% among the two-year-olds, and 37% among the three-year-old children. The most commonly used supplements among the two-year-olds were vitamin D or vitamin A + D combination (38%) and fluoride (16%) and among the three-year-olds fluoride (19%) and multivitamins (16%), respectively. Intake of nutrients other than vitamin D or fluoride from supplements was rare among two-year-olds, whereas 16% of the three-year-olds received also vitamin A, C, E, and several group B vitamins. Mean daily intake of vitamin D from supplements was 6.7 micrograms at the age of 2 years and 5.3 micrograms at the age of 3 years, respectively. The level of parental education was positively associated with the child's vitamin D supplementation at the age of 2 years. As the compliance with national recommendations of vitamin D supplementation was low, intensified counseling of the parents is needed at the well-baby clinics in Finland.

PMID: 15060898 [PubMed - indexed for MEDLINE]


Is it flooding, yes

[Naf9]

The explanation I got about a year ago (without documentation to back it up ) was that there was vit. D in brest milk, but not in the "thick fatty" part of it. The vit. D was in the watery part and that vitamin has to be taken with some fat to be absorbed by the body... (I don't really understand why it does not just mix in the childs stomach )

I just wondered (to add an philosophical angle to the discussion... )... if breast milk is so perfect and has all the ingredients, why did this one "slip"? A mistake in the engineering of the human body??

[efx]

I just wondered (to add an philosophical angle to the discussion... )... if breast milk is so perfect and has all the ingredients, why did this one "slip"? A mistake in the engineering of the human body??

Vit - D deficiency is more seen in the sunlight-poor areas. The mistake may be living in an enviroment without adequate sun light

[raumagal]

I just read an article that said that it used to be recommended that babies "sunbathe" or were generally put out in the sun more often. The practice has changed in recent years due to worries about skin cancer etc.

Maybe it doesn't have anything to do with the "perfect amount of Vitamin D in the breastmilk" or "a mistake in engineering of the body" at all but rather that babies got enough from the sun before and it wasn't needed from breastmilk. That is, maybe the idea that breastmilk should contain all the recommended Vitamin D is an incorrect assumption if humans previously got enough from the sun.

[efx]

Actually the role of sun light is converting the vit-D from one form to another form. So there isn't any vit-d coming with sun

[raumagal]

Actually the role of sun light is converting the vit-D from one form to another form. So there isn't any vit-d coming with sun

I understood that Vitamin D is created in the body when ultraviolet light from the sun strikes the skin (Vitamin D is made in the skin when 7-dehydrocholesterol reacts with UVB ultraviolet light) and is then processed by the liver and kidneys. The sun exposure doesn't provide calcium though which is needed for the vitamin D to be useful.

I was speculating that since breastmilk doesn't contain enough Vitamin D without supplementation perhaps breastmilk isn't the body's intended primary source of the vitamin? Perhaps the human body is programmed to get Vitamin D primarily via the skin's exposure to UVB ultraviolent light?

[efx]

Perhaps the human body is programmed to get Vitamin D primarily via the skin's exposure to UVB ultraviolent light?

Yes
Actually inadequate exposure to the sun light is the primary reason for vit-d deficiency. But if there is not enough diatery vit-d then there wouldnt be enough vit-d to be converted via sun light in the skin which also results in vit-d deficiency -> rickets & osteomalasia(in older patients)

[sammy]

Actually inadequate exposure to the sun light is the primary reason for vit-d deficiency. But if there is not enough diatery vit-d then there wouldnt be enough vit-d to be converted via sun light in the skin which also results in vit-d deficiency -> rickets & osteomalasia(in older patients)

A tangential sidenote... erm... how's the E vitamin thingy in Istanbul? You know, the E... cough cough, exam... or is it, hmm, not a vitamin to be discussed for the moment?

[efx]

[quote="sammy"
A tangential sidenote... erm... how's the E vitamin thingy in Istanbul? You know, the E... cough cough, exam... or is it, hmm, not a vitamin to be discussed for the moment? [/quote]
E ?