The Politics of Vitamin D: Questioning Universal Supplementation

Katherine Barber and Mishawn Purnell-O'Neal
Issue 117, March/April 2003

As early as the spring of 2003, the American Academy of Pediatrics (AAP) may recommend that all breastfed babies receive a daily supplement of vitamin D, based on the belief that breastmilk is deficient in vitamin D and can lead to rickets in babies who are exclusively breastfed. Such a recommendation is paradoxical: While breastmilk is supposedly the best form of infant nutrition (as mothers, physicians, and even infant-formula companies agree), it is somehow lacking in sufficient amounts of vitamin D. This policy could have far-reaching, potentially harmful implications for the work of breastfeeding advocates across the country, particularly in the African American community.

Rickets
Nutritional rickets is a disease characterized by weak bones, poor bone development, and bowed legs, and is caused by a deficiency in vitamin D. (It can also be caused by cystic fibrosis, metabolic disorders, and celiac disease.) The human body needs vitamin D for proper bone growth and calcium absorption. Our primary source of adequate amounts of vitamin D is sunlight, or Ultraviolet B (UVB) exposure. Vitamin D is also found in such foods as salmon and egg yolks. Nutritional rickets is rare in the US, though over the past few years there have been new cases around the country. It's so uncommon, in fact, that until recently there was no national monitoring system to track and study the disease; the Centers for Disease Control (CDC) is just beginning to monitor it. Signs of rickets in infants include slow growth, seizures, the inability to stand or walk, curved bones, large joints, and bowed legs. In the 1920s, researchers discovered that the root of the disease was vitamin D deficiency; since then, many foods, including cow's milk, have been fortified with extra vitamin D.

Vitamin D-deficiency rickets is a public health issue that warrants attention, but not at the expense of breastfeeding. Media attention has mainly focused on exclusive breastfeeding as a cause of rickets; however, an increase in rickets cases may result from the reduced amount of time that people spend in the sun and from women who do not have adequate stores of vitamin D during pregnancy.

It is true that breastmilk has low amounts of vitamin D, but those low amounts are just what breastfed babies need. In rare cases, vitamin D supplements may be appropriate for some breastfed babies, such as those not exposed to the sun because of their parents' religious beliefs and those who live in regions where there is little sunlight.

Experts say that darker skin makes children more susceptible to rickets. This is because darker tones tend to protect the skin from a certain amount of ultraviolet rays, causing an almost natural deficiency in vitamin D. Michal Young, MD, a noted neonatologist and prominent breastfeeding advocate in Washington, DC, told us, " 'Dark-skinned' is a relative term and given to far too many variations. Also, climate conditions, such as cities with a lot of air pollution, can make sunlight a challenge for persons who are not as deeply pigmented."