Friday, July 08, 2011

Vitamin D

Melbourne is a bleak and chilly place at this time of year. My little deciduous Bonsai trees have dropped their leaves. Most days there's not much sunshine - not a lot of synthesising of precious Vitamin D going on in our bodies.



This past week I have been seeking an update of my knowledge of Vitamin D. My questions were prompted when a woman in my care, who gave birth in hospital, was instructed to give her baby Pentavite (R) daily in the first year, to ensure adequate Vitamin D intake. The Penta-vite Liquid Multi-vitamins for Infants (0-3 yrs) contains 10.1 mcg of Vit.D3, as well as Vitamins B1, B2, B3, B6 and C.

The hospital midwife indicated that this protocol was now being followed for breast feeding mothers whose Vitamin D levels tested low.

I inquired about current midwifery practice amongst colleagues, and some were quick to send links to sites and articles on the importance of adequate amounts of the 'sunlight vitamin' in pregnancy, lactation, and infancy.

I recommend a current update article in Medscape ObGyn and Womens Health. Vitamin D, Deciphered, Declassified, and Defined for Your Patients written by Sandra A. Fryhofer, MD.
"In the past, vitamin D worries were mainly about bone health. That's all changed. New studies now support an ever-increasing role of vitamin D in preventing all kinds of diseases: heart disease, diabetes mellitus, cancer, infection, autoimmune diseases (multiple sclerosis, rheumatoid arthritis), and the list goes on!"

Other Medscape articles that provide useful perspectives on this topic are
ACOG Says More Data Needed on Vitamin D During Pregnancy
"June 22, 2011 — More data are needed before physicians start routinely screening pregnant women for vitamin D deficiency, according to a statement from the American College of Obstetricians and Gynecologists (ACOG), published in the July issue of Obstetrics & Gynecology."

Also ...
Protean Manifestations of Vitamin D Deficiency, Part 1 The Epidemic of Deficiency

Protean Manifestations of Vitamin D Deficiency, Part 2
Deficiency and Its Association With Autoimmune Disease, Cancer, Infection, Asthma, Dermopathies, Insulin Resistance, and Type 2 Diabetes

Protean Manifestations of Vitamin D Deficiency, Part 3
Association With Cardiovascular Disease and Disorders of the Central and Peripheral Nervous Systems


One of my midwife colleagues wrote:
"It is so important to get enough in your diet and sunlight. Our society has become sun protective obsessed that we are not getting enough. I would suggest to your client buying the best quality organic butter and slapping it on everything. If she can get hold of raw milk from grass fed cows even better. Fish oil or grass fed free range chook eggs. 10-15 min in the sun (till the skin gets a light pink colour) is enough vitamin D Daily and make sure she doesn't wash her skin after a sun bake. How long to be in the sun depends on how far North or South you live and the time of year. Best time to get your vitamin D is between 10-3pm (the time everyone is shunning the sun). The problem with getting your vitamin D from the sun is knowing when to have enough, people work or lay in the sun for long periods of time are more at risk of skin cancer... but a daily dose of light pink skin is healthy."


Having looked at the evidence and debate I will now be more committed to not only checking Vitamin D levels, and promoting healthy diet and sensible daily sun exposure where possible. I recall advice that was given to mothers in the 1950s and 1960s, that they should give baby time each day in the sun with little or no clothes on, weather permitting. Perhaps we will reinstate this old advice.


PS
July 6, 2011 — Vitamin D supplementation of 4000 IU/day is safe and effective for healthy pregnant women and their infants, according to the results of a large, double-blinded, randomized clinical trial published online June 27 in the Journal of Bone & Mineral Research.

[I checked the amount of Vitamin D in my daily multi-vitamin supplement, and it's 200 IU.  According to the lead author Bruce W. Hollis, PhD: "Surprisingly the scientific debate has made little progress since Dr. Gilbert Forbes made a recommendation of 200 IU (international units) per day in 1963, which was based on a hunch."]

Your comments are welcome.

1 comment:

Less is More Midwife said...

Very interesting, in Scotland we recommend all women at booking to take 10 micrograms of Vit D (and even supply it to those on benefits) but I have never thought of the babies, will look into this further!