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Do Exclusively Breastfed
Babies Need Vitamin D
Supplementation?
Ted Greiner,
Uppsala University
20/07/2015
Ted Greiner
• Vitamin D is
actually not a
vitamin but a
steroid hormone.
• It is made in our
skin when exposed
to ultra-violet
radiation from the
sun.
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Ted Greiner
• It is needed for the absorption of
calcium, which in turn is needed to
make bone and teeth.
• There are receptors for it in most of
the cells in our body so it probably
has some other functions as well.
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Ted Greiner
• Deficiency of vitamin
D and/or calcium
leads to rickets, a
disease in children
in which the bones
grow soft and
deform in shape.
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Ted Greiner
2-year old boy
with rickets from
Eastern Cape
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• In adults this disease is called
osteomalacia.
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• Vitamin D deficiency (VDD) also
seems to lead to increased
susceptibility to infection.
• It seems to have a role in
insulin response and deficiency.
• Especially in the early months of
life, VDD is associated with an
increased risk of developing
diabetes later in life.
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• Vitamin D is not
present in many
foods. It is in
small amounts
in eggs and
butter but NOT
in milk unless
commercially
fortified.
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• It is present in fatty salt-water fish
that feed near the surface and thus
cod-liver oil was used to provide
supplemental vitamin D before it was
available in synthetic form.
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• Recommended intakes vary from
200 IU (5 g) per day for young
infants to 1000 IU per day for
pregnant women. Toxicity can
result from consuming more than
1000 IU a day.
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Ted Greiner
• Vitamin D
transferred
placentally
meets the
needs of
newborns until
about 8 weeks
of age if the
mother was
not deficient.
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Ted Greiner
Can breast milk provide
enough?
• Normally, breast milk can
provide only about 20-50 IU of
bio-active vitamin D per day and
thus cannot prevent deficiency
• One study suggests that it is safe
for lactating women to take
2000, possibly even 4000 IU per
day and that this provides an
adequate amount in breast milk
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Ted Greiner
• The required amount can be obtained
from sunlight but how much is
needed depends on:
– Skin colour
– Amount of clothing worn
– Cloudiness, smog or air pollution
– Use of sun screen (when used
effectively, it prevents formation of
vitamin D in skin)
– How high in the sky the sun is, in turn
determined by:
• Latitude
• Time of day
• Season
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Ted Greiner
Sun exposure is inadequate among
people who:
•veil or sequester women and
children for cultural or
religious reasons
•are too sick or old to spend
enough time outdoors
•are institutionalised.
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Ted Greiner
• Sun exposure NOT
recommended < six
months old:
–increased risk of
skin cancer later
in life.
• Sun exposure
should be for short,
regular periods.
• Avoid long
exposures and midday exposures.
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Ted Greiner
• In Cincinnati (39 N), 30 minutes
a week with only diapers on was
adequate, or 2 hours while
clothed but with head bare.
• At latitudes < 34, sun exposure
works around the year. (SA is at
23 - 35.)
• In cold periods/places,
supplementation may be wise.
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Ted Greiner
• For exclusively
breast-fed infants
< 6 months, 200-400
IU per day
recommended, given
as drops. Often not
commercially
available except
combined with
other nutrients.
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Ted Greiner
• American Pediatric
Association recently
recommended 200
IU daily when EBF.
Some worry of
possible harm.
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• Rickets is increasing in darkskinned people where EBF
increasing (USA and UK).
• Breast milk has 1/5 the calcium
of cow milk.
• If low-calcium supplements
(sugar water; teas) displace
breast milk: Ca deficiency may
result.
• This, not true EBF, may be a main
cause!
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• Commercial milk products and
some commercial infant foods
are the main foods fortified with
vitamin D.
• Not all are and this varies by
country.
• You have to read labels.
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• I recommend
regular vitamin D
supplementation
for all children not
getting enough
vitamin D from
fortified foods,
especially
exclusively breastfed babies.
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Ted Greiner
Moving in August to
P.A.T.H. Washington, DC
www.path.org
Ted’s Email:
[email protected]
Ted’s Website:
www.breastfeedingfortheworld.net
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Ted Greiner