Another health problem attributed to vitamin D deficiency has been identified. And it has something to do with baby delivery. About a hundred years ago, the condition of rachitic pelvis or rickets of the pelvis lead to fatal complications during children. This bone disorder is almost non-existent today because of the discovery of its cause  vitamin D deficiency.

Recent studies, however, indicate that vitamin D deficiency is becoming widespread in industrialized countries, leading health experts to recommend increased vitamin D supplementation.

Boston University researchers report that pregnant women who are vitamin D deficient have 4 times increased risk of having a C-section delivery compared to those who are not vitamin D-deficient. However, it’s not rickets anymore that is the problem but weakness and poor performance of certain muscles. This “suboptimal muscle performance and strength” seems to be linked to vitamin D deficiency.

Vitamin D deficiency has been linked to many health disorders, including heart disease, neurodegenerative disorders, and bone disorders. Vitamin D deficiency during pregnancy has been linked to softening of the baby’s skull and unhealthy baby teeth.

Last Monday, the American Academy of Pediatrics released its newly updated guidelines for vitamin D for children. And here’s what is recommended: vitamin D supplementation doses should be doubled!

The previous guidelines from 2003 recommended 200 IU per day of vitamin D. The new guidelines recommend 400 IU per day.

Some of reasons for this increased dosage are:

• Results from clinical trials indicating vitamin D supplementation can prevent diseases including rickets, osteoporosis, infections, autoimmune diseases, cancer and diabetes.
• Dietary sources of vitamin D are limited. Even mother’s milk supposedly cannot provide enough vitamin D.
• Vitamin D is synthesized by the body upon exposure to sunlight. However, the amount of sun exposure that can provide adequate vitamin D without increasing the risk for skin cancer is not known.

Recommendations for babies are as follows:

• Exclusively and partially breastfed babies need vitamin D supplements of 400 IU per day during the first 2 months of their life.
• All non-breastfed infants and older children who are consuming less than a quart per day of formula or milk fortified with vitamin D should also receive supplementation of 400 IU a day.
• Children taking certain medications that can increase risk of vitamin D deficiency may also need vitamin D supplementation.

As a resident of Switzerland with 2 growing children, I follow this issue of vitamin D supplementation with interest (see previous post on vitamin D deficiency).

You see, our milk here (as well as in many European countries) is not fortified with vitamin D. Yet our doctors never talk to us about vitamin D supplementation (or any vitamin supplementation for that matter), neither for my kids or for me, not even when they were babies partially fed with breast milk. Our almost only source of vitamin D is the sun. Yet, I don’t hear any major problems of vitamin D deficiency. Kids here seem to be as healthy as anywhere else in the world.

Why aren’t European health experts taking the vitamin D deficiency issue seriously? Do I have reason to worry about the health of my kids? Without vitamin D fortification and supplementation, does this mean that European kids will be less healthy their American counterparts?

A recent study gives the following disturbing statistics:

• 40% of American babies and toddlers don’t get enough vitamin D
• 12% of infants and young children are already deficient in vitamin D,
• 28% are at risk for vitamin D deficiency

Those especially at risk are breastfed babies. This is due to the fact that while baby formula is fortified with vitamin D, breastmilk seems to be deficient in this essential vitamin.

Vitamin D deficiency can lead to rickets and soft skulls in newborn babies. It is also linked to multiple sclerosis, osteoporosis, and Alzheimer’s disease.

According to the NIH Office of Dietary Supplements, the American Academy of Pediatrics recommends that breastfed infants (exclusively and partially) should be given vitamin D supplement of 400 IU/day until they are weaned or shifted fully to vitamin D-fortified formula or whole milk.

In a previous post, Tamsen Butler recalls her experience with infant vitamin prescription for her breastfed baby. I can fully understand her feelings. We are fully convinced that breast milk is the best food for our babies and having to give them supplements goes against the grain.

In Europe, giving vitamin D or any vitamin supplement for that matter to infants is not a common practice. Breast milk is usually deemed to provide all the nutrients that a baby needs in the first months. I mixed-fed my twins for 4 months with pumped breast milk and formula. They needed a special formula for premiees because they were born premature with low birth weights. However, they never got any vitamin supplements at any time nor did our paediatrician ever mention it. At 12 months, like most German children of their age, they were drinking the normal milk we buy in the supermarket with 1.5% fat content but unfortified with vitamin D.

Older children in the US are also at risk for vitamin D deficiency. This is because vitamin D in the food we eat is very limited. Instead, our main source of vitamin is sun exposure. Supplementation is also recommended for older children and adolescents who don’t get the recommended daily intake of vitamin D in their daily diet.

While most milk products in the US are vitamin D-fortified, this is not true in Germany and Switzerland and many other European countries. Some foodstuffs though like breakfast cereals and fruit drinks may be fortified. However, our main source of vitamin D in Europe is still sun exposure. In winter time in Zurich where it can be pretty foggy, train signs would tell the passengers which mountain they should go to get some sun.

In recent years, there is more pressure for supplementation, even in Europe. Vitamin D deficiency is especially prevalent in northern European countries in spring and winter. Finland started fortification of some food products in 2005. In 2007, the Irish Food safety Authority (FSAI) recommended a nationwide supplementation in infants under 12 months old. In recent years, vitamin D deficiency has become a global problem. Lifestyle changes all over the world led people to spend less and less time outdoors, thereby less exposure to the sun. Even Singaporeans who live right smack on the equator are having health problems from lack of sunlight.

However, the practice of routine vitamin supplementation is still a subject for controversy. Many health experts recommend that exposure to midday sun without sunscreen is the best way to get vitamin D. Dermatology experts maintain that diet and supplements, and not sunshine should be the main source of vitamin D. This is to counter the risk for skin cancer. The American Heart Association does not recommend taking vitamin supplements in general.