Admittedly, I am a political junkie. For those of you who missed Senator Barack Obama’s acceptance speech, he reassured his supporters by saying, “I get it,” then added, “John McCain is a good man. But John McCain doesn’t get it.” 

More recently members of the media, describing Governor Palin, stated, “She gets it.”

Apparently, getting it is what it’s all about these days. Either you are in the know or you are in the dark.

And since we’re on the subjects of who gets it and who doesn’t, I’d like to discuss a recent article by New York Times reporter, Roni Caryn Rabin, entitled, “Vitamin D Deficiency May Lurk in Babies.”

According to Rabin, “Physicians have known for more than a century that exclusive breastfeeding may be associated with vitamin D deficiency and rickets, and that the condition is easily prevented and treated with inexpensive vitamin drops or cod liver oil. But doctors were reluctant to say anything that might discourage breastfeeding.”

I find Rabin’s suggestion that physicians would compromise the health of babies in the interest of breastfeeding at the very least presumptive.

It serves only to show that Rabin doesn’t get it.  

Rabin’s statement highlights her lack of understanding of this complex issue. And she’s not alone. For centuries, the primary source of vitamin D for adults and older children has been the UVB rays of the sun. Unborn and newborn babies and young children have relied upon their mothers to meet their vitamin D needs—initially via the placenta and later through breastmilk. Until recently, the sun proved to be an ideal source. But alterations in lifestyle and changes in environmental conditions have converted a previously safe source into an unsafe one.

The risks associated with sunlight exposure including skin cancer, melanoma, and cataracts have been highly publicized, and rightly so.  In 1998 there were 51,400 new cases of melanoma and 7800 deaths reported in the United States; an increase of 50% since 1973. Children as well as adults now spend more time indoors and when they are outdoors they shield their skin from the sun with clothing and sunscreen (which when properly used reduces vitamin D synthesis by 97 percent.)

If Rabin got it, she’d know why vitamin D is found in few foods. It isn’t a vitamin at all, it’s a sterol. Sterols are compounds that behave like fats and are classified as lipids. Vitamins are essential nutrients that typically cannot be produced in the body and therefore must be obtained in foods. In contrast, vitamin D is synthesized in the skin on exposure to sunlight and occurs naturally in only a few foods (most notably egg yolk, fish oil, and human milk). uman HuH

So when Stephanie Remy-Marquez, mother of a baby diagnosed with rickets was quoted by Rabin as saying, “Breastmilk is supposed to be an entire meal, dessert and drinks included,” Remy-Marquez was right. Human milk typically contains all the nutrients (including vitamin D) a baby needs and in just the right amounts, assuming a mother’s vitamin D status is normal.

It’s not about the milk. It’s about the sun.  

It’s not about the babies. It’s about the moms.

Until researchers find a way to make adequate exposure to sunlight safe or find a safe alternative to sunlight, the incidence of vitamin D deficiency in mothers will continue to rise. Commonsense tells us that if more mothers are vitamin D deficient during pregnancy and while breastfeeding, than more babies will be vitamin D deficient at birth and while breastfeeding, especially those who breastfeed exclusively.

But there should be no debate over the adequacy or superiority of human milk. Instead the debate should be about how best to compensate for a change in lifestyle that has occurred so quickly, the body hasn’t had a chance to adapt, and what role human milk can play in meeting babies’ vitamin D needs.

Solutions

One possible solution is to add vitamin D to foods that are commonly eaten by infants and young children, such as infant formula (artificial baby milk) and cow milk. This solution works well for babies that are not fed normally (exclusively breastfed for the first six months of life). But this solution presents a challenge when babies are fed normally.

Another solution would be to supplement the breastfeeding mother’s diet in an effort to increase the amount of vitamin D in her milk. Research in this area is currently underway, and early trials suggest that mothers might need to take as much as 4000 to 10000 IU of vitamin D each day to achieve desired levels of vitamin D in their milk. Stay tuned.

A third option would be to give all exclusively breastfed babies a supplement of vitamin D each day.

Perhaps the obvious solution is that there is no one size fits all solution. While a call for universal supplementation of all breastfed babies beginning shortly after birth may be an effective strategy, it requires universal cooperation on the part of parents.  A scenario that history has taught is difficult to achieve.

Ultimately, parents and health professionals must assess the individual needs of each infant and child and develop a plan of care that best meets those needs, taking into consideration all of the factors that influence vitamin D levels. Informed decision-making should be everyone’s goal. That means basing decisions on facts not fiction.

When a decision is made to supplement a breastfed baby with vitamin D, how the health care provider frames the message is critical. A health care provider that gets it, will focus on the importance of vitamin D and the possible role of human milk in meeting a baby’s vitamin D needs in a changing environment. And if the health care provider gets it, you can be assured the mother will get it too.

One final admission—Rabin to some extent does get it, as demonstrated by her attempt to raise awareness about a serious health concern.

To underestimate the importance of vitamin D would be naïve given the growing body of evidence. But to suggest that human milk is deficient in vitamin D ignores the fact that human milk was never meant to be the primary source of vitamin D.

With the resurgence of the musical “Hair,” perhaps we need to reconsider the advice contained therein.

Let the sun shine. Let the sun shine. The sun shine in.

If only it were that simple.