Sunday, November 22, 2009

Are you and your child getting enough vitamin D?

Do breastfed infants need supplemented vitamin D?
When to start giving your child vitamin D?
How much vitamin D do children need?
In what form should I give my child vitamin D supplements?

I'm sure these questions have plagued all parents for years now and unfortunately there still are no absolute answers. Ok, the state-provided health care system for expectant mothers and children (Neuvola), will recommend 10 micrograms (400 IU) every day after the age of two weeks. Is this reasonable? According to current research the prior RDA of 200 IU for infants is too little, and at least the current recommendation 400 IU is desirable. Last year American Association of Pediatricians (AAP) started recommending doubling the dose and starting this year the same has happened in Finland. With the knowledge we have today it is reasonable to have confidence that this dose is both safe and adequate for all children. The supplements should be started at latest at 2 weeks of age, AAP even recommends just after the first few days.

But is there individual variation? Can there really be one RDA from infancy until adolescence, which is the same even for children living in different climates? Naturally genetics, overall diet and exercise as well as sunlight exposure will affect how much supplemental vitamin D is needed. If an infant or child consumes no dietary added vitamin D, there is no indication that there is any risk of side effects due to excessive intake of vitamin D from a 10 microgram supplement. This is of course different, if a baby for example is consuming D-fortified formula or a child is drinking fortified milk and eating other fortified foods. In these cases the parent needs to make the appropriate calculations to make sure that the child is not exceeding the RDA on a regular basis.
Personally I do not advocate offering children any vitamin D fortified foods as these usually are foods that need to be fortified because they are otherwise deficient in nutrients (such as sugar-coated cereals). Some even contain the wrong form D2 instead of the needed cholecalciferol D3, such as Keiju oat milks in Finland. If at all possible, it is best to consume all food in it's natural and organic state, without anything added. Unfortunately due to our dark climate and limited sun exposure we need to supplement vitamin D.

There is some research into whether nursing babies need supplements or if they get enough from breastmilk. So far the leading consensus is that not enough vitamin D is transfered into the milk and therefore it is advisable that even breastfeed infants receive D-drops. As long as the 400 IU supplement is the only external source of vitamin D, it is considered safe.

Fatty fish are the best natural dietary source of vitamin D. For Finns I especially recommend herring (1627 IU/100g) and mackerel (cooked 345 IU/100g), because they are readily available here. Vitamin D in plants is usually in D2-form, which is why vegans especially need a good quality D3 supplement.

The best vitamin D supplement for infants 0-2 yrs and over I have found to date is Carlson's d-drops (picture above):

First of all, they are nothing but 400 IU of D3 in coconut oil. Second of all, you only literally need one DROP, which can easily be dropped on the nipple before nursing an infant or in food for older children. No GMO, gluten, sugars, additives, preservatives, alcohol or any other junk. They are even ridiculously cheap, that one 11 ml bottle contains enough for an entire year! Of course this also makes it eco-friendly. Iherb will also ship to Finland via airmail for 4-6 dollars.

Compare Carlson's drops to for example the commonly Neuvola-recommended Deetipat:
Ingredients: "Sakkaroosi, natriumsitraatti, makrogoliglyserolihydroksistearaatti, sitruunahappomonohydraatti, alfa-tokoferoli, keskipitkäketjuisia tyydyttyneitä triglyseridejä, väkiviina 96 %, puhdistettu vesi."
So 96% alcohol, sugar, saturated fats. I can't believe that this is even legal.

For adults a beneficial but safe dose is around 25 micrograms or 1000 IU. Some choose to take even more, I myself take 2000 IU daily. Now Food's supplements are high quality with minimal added ingredients and they are also far cheaper than many of the supplements sold here in pharmacies. Also available at iherb and many other online stores.

Breast milk as a source of vitamins, essential minerals and trace element. Christopher J. Bates and Ann Prentice. Nov 2002. DOI:10.1016/0163-7258(94)90011-6.


HW said...

Good post!

Our Neuvola actually recommends Jekovit, which is a product of Orion Pharma. I have heard that in some Neuvolas they even give you a product sample of Jekovit when your baby is born: "so, it's time to start Vitamin D when your baby will be 2 weeks - here is the first bottle". And many new parents are not even aware of other options! Terrible marketing.

We also used Jekovit first with our 1st child and then I found out that it only contains D2, not D3. Many parents who were aware of this seemed to use Deetipat, which was kind of an "alternative" product and seemed much better. So all our kids have now used Deetipat for their first year and I have to admit feeling a little bit quilty because of that. :(

Our recent Deetipat bottle is starting to become empty and it is time to think what comes next. Carlson drops seemed to be out of stock on iHerb :( so I went to local Life store and bought some "GimmeFive" (Disney co-branded) drops. They only include vegetable oils and D3, nothing else. My first impression was annoyance as I dislike Disney and their co-marketing efforts with kids' health business, but there were no other options available and I think this is better than nothing (and better than the "mainstream" drops...)

Aletheia said...

Too bad Iherb was out of stock! I also have seen these Disney-D's, and I actually looked at the bottle in horror because I thought I'd find all the additives and colorings in the world. Boy was I suprised to see it was only oil an D3! Annoying branding I agree, I think they should emphasize the fact that they are additive-free rather than try to sell the product with disney figures. But you are right, these are miles ahead of Jekovit and Deetipat. They really should not be on the market, much less recommended by doctors and nurses. Parent's trust these sources which makes it so sad to know how their opinions are influenced by money rather than children's health and well-being.

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