Interviewer: We read everywhere that the best thing you can do for the young child is to breastfeed it but, at the same time, deficiency is more common in breastfed kids. Why is that and, you know as a mother what can you do to make sure that your infant is getting the nutrients it needs including vitamin D?
Dr. James Dowd: So vitamin D is very common in pregnancy and in the immediate postpartum period which is exactly the window when we're breastfeeding, okay? Studies in Pittsburgh show that about 50-60%, it depends on when they measured in the pregnancy, but 50-60% of European American women are deficient in the latter stages of pregnancy and that 90-some-odd percent, 90-plus percent of African American women are deficient in the latter stages of pregnancy. And then, at confinement, at birth, the infants retain that deficiency. In other words, some 90-95% of African American newborns are vitamin D deficient at birth and about 50-60% of Caucasian infants are vitamin D deficient at birth. Now if this deficiency continues in the next... in the ensuing months, which it typically does, then the mother's breast milk is going to contain very little vitamin D as well. Hence the recommendations by the American Academy of Pediatrics that you should fortify a breastfed infant with vitamin D.
But a better solution is to kill two birds with one stone here and fortify the mom enough that the levels in her breast milk are normal. Normal, not typical but normal, okay? And then you're not only replenishing mom's low D levels, which will help her recuperate, if you will, from her pregnancy, because a pregnancy can be very draining and she needs to put calcium back into her bones and things in this recovery period, but will also enhance the vitamin D levels in her breast milk and provide enough for the infant. And Bruce Hollis out of South Carolina, Medical College of South Carolina, it's two NIH grants, one was to look at the safety of high-dose vitamin D during pregnancy and the other study was to look at high-dose supplementation in breast feeding women and how much supplement would you need for enough to show up in the breast milk so that the vitamin D level in the infant was normal, okay? First piece: 4,000 units a day throughout pregnancy. Nobody dropped out of the study because of complications or problems from being on that dose, okay? And in fact there seemed to be fewer pregnancy complications in the group getting vitamin D, okay? So it seems to be pretty benign during pregnancy, okay? And may actually reduce the risk of pre-eclampsia and some other pregnancy complications and that's been shown in other studies that there is a relationship between pre-eclampsia and vitamin D deficiency. The lower your vitamin D level the higher your risk of pre-eclampsia as an outcome for your pregnancy.
Then let's move to breasfeeding, the postpartum period. Bruce Hollis found that at 4,000 units a day there was a modest amount of D showing up in the breast milk but the vitamin D levels in the infants did not quite reach normal and that it took 6,000 units a day, on average...I mean he was just using set doses. I usually recommend you replace based on weight so that you target specific to one person rather than everybody get the same dose because size matters and bigger people need more and little people need less. But in this study they just used a set dose. They tried 4,000, they tried 6,000. Six thousand, at 6,000 units a day, roughly, these women seemed to have adequate amounts in their... not only was their blood normal, their blood levels were in the high 40's/low 50's, but there was enough now in the... in their breast milk that the infants vitamin D level was normal breastfeeding on those women. So these are big numbers. I mean some will say, I'll take a thousand units a day, that's probably not scratching the surface. You need more than that to get your level to normal and certainly when you're breastfeeding because the amount that shows up in breast milk is only a fraction of what you have in your blood stream you need to have a level that's well within the normal range for enough to be in the breast milk for the infant.
Interviewer: What about when the kids get a little bit older, we're always told to drink our milk when we're kids and vitamin D fortified milk, is that a good way to get vitamin D for the kids that are in the three-to-older range?
Dr. Dowd: Milk as a source of vitamin D is useful probably in the first two years of life and that's even pushing it, okay? There's a hundred units of vitamin D, supposed to be a 100 units and Michael Holick did some studies saying that there's quite a bit of variability from one manufactured milk to another as to how compliant they are with this FDA recommendation. But 100 units per eight ounce glass of milk. If the requirement for a child who's about a year old is 2-400 units a day that's 2-4 eight ounce glasses of milk a day. If the requirement for a three or five-year-old is closer to 800 units per day that's eight glasses of milk a day and you can see where this is going. For an adult it's 20-30 glasses of milk a day. There's just no way you can get enough milk, you'll make yourself sick. I'm not a big fan of dairy because, for a multitude of reasons, number one it raises insulin levels, number two it's the most allergic food on the planet. When you talk to a food allergist they'll say "well what's the number one food allergy? It's dairy, it's always dairy, it's always been dairy." It's loaded with carbohydrates and fat unless your drinking fat free but if... so you drink fat free, it's still loaded with carbohydrates. There's a lot of simple sugar in there and the simple sugar plus the protein really shoot up insulin levels. It's just not... it's a food that was designed, it's loaded with growth hormones, it's loaded with sugar and protein, and it was designed to enhance insulin secretion in a new born to facilitate growth; it's baby food. It's for babies, and only for babies. Cows don't put vitamin D in milk. That's a requirement by the USDA and the FDA that it be fortified with A and D to prevent rickets and those policies date way back, many decades back. So milk, unpasteurized milk that has nothing added to it, certainly will do very little, if anything, in the way of preventing rickets even because there's no D in unpasteurized raw milk. So D was a useful tool in it's time. It's still a useful tool at a certain age range but certainly as you approach the age of two milk loses it's utility, rapidly loses it's utility and then you need to think about supplementing these kids who are not getting enough sunshine. At the very least checking their level and seeing that they're not... making sure they're not deficient and if they are then either fortifying their diet or giving them a supplement, doing something to correct that deficiency.
How is that the case? We're told breast feeding is the best thing you can do for newborns. Dr. James Dowd explains how breastfeeding babies can still be deficient. He also explains why the popular recommendation to supplement the baby doesn't make as much sense as another option.
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