August 24, 2016



 
Director's Letter 
Carole Baggerly 
Director, GrassrootsHealth 


Breastfeeding is one of the most perfect forms of food for a baby though it has long been "understood" to be an inadequate source of vitamin D. 

How can that be? 

If you know that most women of childbearing age are vitamin D deficient, it starts to make sense that they wouldn't have the vitamin D available to pass on in their breast milk. 

Is it really that simple - if you give women enough vitamin D will they pass it on to the baby? 

Researchers at the Medical University of South Carolina (MUSC) tackled this question with the hypothesis that if a breastfeeding mom receives much more than the standard 400 IU/day of vitamin D, she will be able to pass on an adequate amount of vitamin D to her infant. After a double-blind randomized controlled trial they found that a daily vitamin D supplement of 6400 IU did indeed allow the mothers to pass enough vitamin D through breast milk so that their babies did not need a vitamin D supplement! The average 25(OH)D level of the women who received 6400 IU/day was about 60 ng/ml.  The infants nutured this way had the equivalent of the 400 IU/day that is currently recommended by the American Academy of Pediatrics.

You can give babies a supplement, but only 2-19% of the infants are given a supplement.  This suggests that over 80% of babies are not getting the recommended amount of vitamin D. 

You can expose babies to sunshine, but your pediatrician has probably told you to keep your baby out of direct sunlight for at least the first 6 months and to make sure they are covered with clothing or sunscreen when they do go outside. (We don't recommend this.)

This is a problem! Not enough D in breast milk, no supplementation, and no sun puts far too many babies at risk of vitamin D deficiency, and at increased risk of many future diseases that could be avoided. 

We are now working at MUSC to change the standard of care for the pregnant women--getting the serum levels to at least 40-60 ng/ml.  We need to take the next step:  make sure that the breast fed baby ALSO has enough vitamin D.  The easy way to do that is for the mom to take 6400 IU/day while she breast feeds the infant.

Onwards!

Carole Baggerly
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice NOW!
Baby-Friendly Hospitals 
What are they and how do they help?

 In 1991, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) created the Baby-Friendly Hospital Initiative (BFHI) to encourage hospitals to provide optimal care for infant feeding, and to recognize hospitals that have feeding programs in place. Now, there are over 20,000 hospitals world-wide that have been certified as Baby-Friendly . BFHI reports that breastfeeding is the single most powerful way to reduce the common causes of infant mortality. In addition to being beneficial for infant health, breastfeeding also provides health benefits for the mother with a reduced risk for breast and ovarian cancers as well as osteoporosis. In addition, it impacts the health dollars of the family in the hundreds of dollars, and health care for the US in the billions of dollars. 

To be certified as Baby-Friendly, a hospital or birthing facility must follow the Ten Steps to Successful Breastfeeding:
  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast milk, unless medically indicated.
  7. Practice rooming in - allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
The Medical University of South Carolina, where GrassrootsHealth's first Protect our Children NOW! initiative is running, is a certified Baby-Friendly hospital. 

"We were happy to join the Baby-Friendly Initiative in 2013," said Sarah N. Taylor, MD, MSCR, Associate Professor of Pediatrics in the Division of Neonatology at MUSC. Dr. Taylor is part of the MUSC Pediatric Nutrition Science team which includes research in vitamin D health, breast milk, gut health, and infant growth. "Coaching parents on breastfeeding is rewarding, and the Baby-Friendly Initiative gives us a structure to ensure every parent is getting information and support on breastfeeding. Being at MUSC, the leading vitamin D hospital for pregnant women, we can also discuss the importance of daily supplementation or sun." 
Paper of the Week 
Vitamin D Supplementation During Lactation
 

Dr. Bruce Hollis Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial
Bruce W. Hollis  et al.
Medical University of South Carolina
Pediatrics
October 2015
 
This research paper documents the results of a randomized controlled trial (RCT) of lactating mothers and their infants. It divided the women, at 4-6 weeks post partum, into one of three groups:
  1. Mother takes 400 IU/day vitamin D (placebo and prenatal vitamin with 400 IU), infant supplements with 400 IU/day vitamin D (1 drop liquid suspension). 
  2. Mother takes 2400 IU/day vitamin D (2000 IU and prenatal), infant takes no vitamin D supplementation (placebo liquid drop). (This group was cancelled about 4 years into the study due to an increase in infant vitamin D deficiency (defined as 25(OH)D < 20 ng/ml)).
  3. Mother takes 6400 IU/day vitamin D (6000 IU and prenatal), infant takes no vitamin D supplementation (placebo liquid drop). 
Previous research found that if the mother was only taking the recommended daily allowance of 400 IU per day, then an infant, solely fed on breast milk, would get the equivalent of 33 - 68 IU vitamin D /liter, which would provide the infant with far less than the recommended 400 IU/day.  Hollis' latest study (2015) reported those infants (at the beginning of the study) to have vitamin D levels < 5 ng/ml (< 12.5 nmol/L). 
 
Even though the American Academy of Pediatrics recommends supplementing infants with vitamin D right after birth, studies show a compliance of between 2 - 19%. Hollis calls infant supplementation "a largely failed initiative."




How do we get these babies the vitamin D they need?

This RCT concluded that giving mothers 6400 IU vitamin D /day made sure the mother became sufficient (this equated to an average vitamin D level of around 60 ng/ml) AND infants became sufficient (with an average vitamin D level a little above 40 ng/ml). Many other measurements and blood tests were taken, including weight, length and head circumference of infant, which were similar for both groups.

6400 IU vit D/day = Sufficient mother AND baby
 
 

As outlined in Pediatrics, October 2015

WHAT'S KNOWN ON THIS SUBJECT: The vitamin D concentration in breast milk of women taking 400 IU vitamin D per day is relatively low, leading to vitamin D deficiency in breastfeeding infants. As a result, the American Academy of Pediatrics recommends breastfeeding infant vitamin D supplementation within days after birth.
 
WHAT THIS STUDY ADDS: Maternal vitamin D supplementation alone with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy the requirement of her nursing infant and offers an alternate strategy to direct infant supplementation
 
Daily intake is most important

One of the most important take-away messages from this research is that breast milk can be an adequate source of vitamin D for the infant, if the mother takes enough of a supplement daily! (Adequate daily sun exposure would also have the same result, but that was not part of this research study.) 

In earlier research, Hollis analyzed how vitamin D is transferred from the mother to the baby and found that it is transferred primarily in its parent form as vitamin D3 rather than 25(OH)D, the compound that is most commonly measured in blood. Vitamin D3 has a half life of approximately 12 - 24 hours, and thus has to be replenished daily; 25(OH)D has a half life of approximately 3 weeks, so intermittent dosing can maintain high levels.

Hollis recommends the standard of care for breastfeeding mothers to be 6400 IU vitamin D / day. This is safe and effective and ensures both mother and baby will become vitamin D sufficient.
Editor's Letter 
Susan Siljander 
Marketing Director, GrassrootsHealth



I think one of the most common misconceptions around vitamin D is that you can take it weekly or monthly and have the same benefit. I have written many of these newsletters, and read a lot of articles online. I have searched through the databases of research papers. I think this misconception stems from the fact that most of the research on vitamin D is about bone health. Even now, about 15-20 years after the first studies for immune function, there is probably 10 times the number of studies on bone health. And bone health only requires 25(OH)D - which has a 3 week half life!

Please note that for breastfeeding moms, it is very important that the vitamin D be taken daily. (GrassrootsHealth recommends daily intake for all conditions, however.)

As always, please share this news with women who are pregnant, or within that age range. You could change many lives!

Have a great week.

Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization  
Moving Research into Practice NOW!

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Vitamin D Requirements of the Pregnant Woman; NICHD Vitamin D Lactation Summary Data
Carol L. Wagner, MD
Medical University of South Carolina
Presented at GrassrootsHealth Seminar
December 2014
 
43 minute presentation about vitamin D and pregnancy health outcomes - for mother and baby, as well as vitamin D requirements for lactating mothers.
 
References
Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial
Bruce W. Hollis, et al.
Medical University of South Carolina
Pediatrics
October 2015
 

Relationships among Vitamin D, 25-Hydroxyvitamin D, and Vitamin D-Binding Protein Concentrations in the Plasma and Milk of Human Subjects
Bruce W. Hollis, et al.
Medical University of South Carolina
The Journal of Clinical Endocrinology & Metabolism
January 2009


The Role of the Parent Compound Vitamin D with Respect to Metabolism and Function: Why Clinical Dose Intervals Can Affect Clinical Outcomes
Bruce W. Hollis and Carol L. Wagner
Medical University of South Carolina
The Journal of Clinical Endocrinology & Metabolism
December 2013


GrassrootsHealth Newsletter
Daily Dosing
July 2015


Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study
Sharon L. McDonnell, et al.
PLOS One
April 2016


Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011 rates
Carol L. Wagner, et al.
The Journal of Steroid Biochemistry and Molecular Biology
October 2015


Incidence rate of type 2 diabetes is >50% lower in GrassrootsHealth cohort with median serum 25-hydroxy-vitamin D of 41 ng/ml than in NHANES cohort with median of 22 ng/ml
Sharon L. McDonnell, et al.
The Journal of Steroid Biochemistry and Molecular Biology
July, 2015


Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery
Carol L. Wagner, et al.
The Journal of Steroid Biochemistry and Molecular Biology
April 2015


Letter to Veugelers, P.J. and Ekwaru, J.P., A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D.
Robert Heaney, et al.
Nutrients
March 2015


Quantifying the food (and non-food) sources of basal vitamin D input
Sharon L. McDonnell, et al.
Journal of Steroid Biochemistry and Molecular Biology
November 2013


25-Hydroxyvitamin D in the Range of 20 to 100 ng/ml and Incidence of Kidney Stones
Stacie Nguyen, et al.
American Journal of Public Health
October 2013


A Novel Approach Localizes the Association of Vitamin D Status With Insulin Resistance to One Region of the 25-Hydroxyvitamin D Continuum
Robert P. Heaney, et al.
Advances in Nutrition
May 2013


All-Source Basal Vitamin D Inputs are Greater Than Previously Thought and Cutaneous Inputs are Smaller
Robert P. Heaney, et al.
The Journal of Nutrition
March 2013


Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention
Cedric F. Garland, et al.
Anticancer Research
2011

 

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