Vitamin D

by Stephanie Sanchez, RN, IBCLC, Birth Assistant

Ahhh, good ‘ol vitamin D… the “sunshine” vitamin. Surely you’ve been nagged by someone in your life about the importance of getting enough of this essential vitamin: maybe it’s your farmer dad urging you to get your daily 20 minutes out in the sun, or your grandmother trying to get you to take that daily spoonful of cod liver oil (ewwww) or your partner who is on a health/food kick and alerting you to aaaallll the nutrition labels, or maybe it’s your lovely DAL midwife reminding you to get your 4000IU* daily for a healthy pregnancy (don’t forget—-it’s in the Birthing Your Baby book!!!) 

We know that adequate intake of vitamin D is essential for bone growth and prevention of rickets in children, hence all of the vitamin D fortified milk, juices, and cereals. But what else? Over the past decade we’ve been learning more about adequate levels of this vitamin and the beneficial impact it may have on our immune systems. It also decreases inflammation, thus improving our ability to fight off infection, and also maybe certain cancers, diabetes, hypertension, and autoimmune conditions. It’s also being studied for its possible benefits for mental health!

And while here in New Mexico we do have the advantage of 300+ days of sunshine per year (did you know NM is actually the 4th-sunniest state in the US, behind Arizona, California, and Nevada?), here in Albuquerque we are just barely below the 35th parallel which is the latitude that has been dubbed as “good for sunshine year-round.” For the rest of the US population living north of us however, the sun’s rays are not strong enough most months to assist humans with making enough vitamin D, which is one of several reasons why most Americans have inadequate levels of vitamin D. Other reasons are the ones you can easily guess: sedentary indoor lifestyle, poor diet, and/or obesity. Other risk factors for inadequate vitamin D levels include being an older adult, having dark skin (increased melanin in darker skin reduces the skin’s ability to produce vitamin D from sunlight), and being a breastfed infant. 

That’s right– being a breastfed infant is a known risk factor for vitamin D deficiency. If you’ve had a baby, especially in a hospital in the past 10 years, you’ve likely been sent home with a prescription or recommendation for giving your baby daily vitamin drops if you are planning on breastfeeding. In 2008, the American Academy of Pediatrics (AAP) recommended that any breastfeeding infant, regardless of whether they are being supplemented with formula, should be supplemented with 400IU of vitamin D daily. This recommendation stems from the fact that maternal vitamin D deficiency or inadequacy is VERY common. Newborns are also at higher risk as they don’t get the opportunity to synthesize vitamin D from sun exposure — as per another recommendation from the AAP that infants under six months of age should be kept out of direct sunlight, and protective clothing, hats, and sunscreen are recommended for any time outdoors. And the question we often hear is “but do I really need to give my baby these drops?” Maybe you don’t like the other added ingredients, or maybe you just flat out will not remember or keep up with it… hi there, and welcome to parenting a newborn where you don’t remember what day of the week it is or what you ate for breakfast much less anything else!

And the answer is… well… yes and no. YES your baby should get the recommended 400IU of vitamin D daily, BUT there’s more than one way to get there! In fact, just by increasing mama’s daily vitamin D intake, you can then provide breastfeeding babes with the recommended 400IU daily, just through breastmilk! No extra vitamin drops necessary! Dr. Bruce Hollis led a randomized control trial of maternal vs. infant vitamin D supplementation during lactation (published in “Pediatrics” in 2015; article linked here). His study refutes the misconception that low vitamin D concentrations are an inherent defect in human milk, but rather proves that the flaw is actually in the dietary recommendation of vitamin D with respect to the lactating mother. He found that maternal vitamin D supplementation with 6400IU daily allows the lactating mother to fully transfer from her blood to her milk the required 400IU daily to her nursing infant, with no additional supplementation required by the infant. This 6400IU number is based on maternal supplementation dosing in previous studies that determined that for every 1000IU per day of vitamin D3 ingested by the mother translates to about 80IU per liter in her milk for a nursing infant. 

This recommendation for a nursing mother does not differ greatly from what DAL already recommends during pregnancy, which is 4000IU of vitamin D3 daily. You can also assume that your daily prenatal vitamin also contains vitamin D3, but the amount can vary pretty widely between brands. Doing some research on a few common brands, I found they varied from 400IU to 2000IU of vitamin D3 per tablet. You can also factor in (the not super significant) average dietary intake of vitamin D for most women with a healthy diet is around 200IU per day. Very few foods are naturally high in vitamin D (fatty fish are the best with about 600IU per serving). Vitamin D fortified milks provide about 120IU per 1 cup. Then of course, there’s one of my best friends, the sun. The amount of vitamin D synthesis via sun exposure (specifically UVB radiation) is the most difficult to quantify due to many factors (season, time of day, cloud cover, skin melanin content, sunscreen). It’s also important to note that UVB radiation does not penetrate through glass, so time sitting in your car or a sunny window doesn’t really count! Not to mention that UV radiation is a known carcinogen and the most preventable cause of skin cancer… so, yeah, probably not the best option. 

In conclusion, yes your baby (and you!) need adequate vitamin D for overall health. While the recommended level varies for adults, for infants it has been determined by the American Academy of Pediatrics that 400IU per day is optimal. For baby’s needs, you can get there by EITHER supplementing the breastfeeding mother with 6400IU daily, OR giving baby vitamin drops at a dose of 400IU daily. Either way, consistency is key, so determine which is the most ideal routine for your family. Wishing you all continued health and sunny days ahead!!!

XO–Stephanie 

Stephanie lives here in the sunny North Valley with her hubby (whose support makes it possible for her to do this intense work) and their two little girls (plus 2 dogs, 2 cats, and 17 chickens — ALL girls).

When not working with mamas and babies, she’s fulfilling her other loves of farming, cooking, outdoor exploring, raising strong girls and showing them the world! She is thrilled to be here working with this amazing group at Dar a Luz supporting the women in this community, their health, and their families.

*IU is an International Unit, usually used to measure fat soluble vitamins including Vitamin A, D and E.
The conversion of IU to mg varies depending on the nutrient.

VITAMIN D
One microgram of Vitamin D = 40IU.
400IU of Vitamin D = 10ug