Vitamin Information Center

The human body is an amazing factory, with all kinds of parts working together to make chemicals necessary for good health. But one thing it can’t make on its own is vitamin D. Research shows that defect can be troubling, especially among children.

To create vitamin D, which plays an important role in bone health and development, the body needs exposure to sunlight. As some countries move into autumn, the days get shorter and colder and exposure to sunlight decreases, making the colder months of the year a crucial time to watch vitamin D intake. Supplements can play an important role but one question is, how much?

Most of a child’s bone mass is built up early. A vitamin deficiency can prevent a child from building adequate bone mass now, and they won’t be able to make it all up later.

Although a study released this week found that vitamin D deficiencies are common in children around the world, there is minimal data on how much supplementation is necessary or safe.

Vitamin D is a fat — soluble vitamin directly or indirectly involved in several key body processes: regulating calcium and phosphorus levels in the blood, promoting bone formation and mineralisation, restricting parathyroid hormone secretion and promoting anti-tumour activity.

A review of medical literature on the vitamin published last year in The New England Journal of Medicine found that vitamin D is also associated with a reduced risk of type 1 diabetes in children, and may inhibit future hip fracture.

The main source of vitamin D is sunlight, which the body uses to convert vitamin D into a useable form. It’s also found naturally in eggs and fatty fish like salmon or tuna, and milk and some breakfast cereals are fortified with the vitamin.

The Institute of Medicine recommends that children get 200 IUs of vitamin D daily, but some experts say that up to 800 IUs is better.

The new study found that high doses of the vitamin were safe for children, whether taken over the short-term or for a longer period of time, and helped increased bone mass in 10 to 17 year olds.

A study released this summer found that even children who are otherwise healthy can have low levels of vitamin D, resulting in low levels of bone mineral content.

The risk for low vitamin D levels begins in infancy —breast milk, like cow’s milk, is naturally low in vitamin D. And if a mother doesn’t have enough vitamin D, her breast milk won’t either.

A vitamin D deficiency can affect bone growth even if there are no obvious problems.

A bottle of vitamin supplements
The American Academy of Paediatrics says that rickets, bone softening that can lead to fractures and deformity, in infants due to low vitamin D intake is seen in several US states.

The agency recommends that breast-fed infants receive vitamin D supplement drops.

Children at risk
“It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IUs of vitamin D per day beginning during the first two months of life,” said a clinical report for the health agency done by Dr Lawrence Gartner and Dr Frank Greer.

“In addition, it is recommended that an intake of 200 IUs of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual.”

The risks to bone health don’t end in infancy.
A Canadian study released last year found that despite guidelines for its prevention, vitamin D-deficiency rickets in childhood is still seen in the country, with an annual incidence of 2.9 cases per 100,000.

Children living in countries where exposure to sunlight is low had the highest incidence, and most of the affected children had medium to dark skin tones and had been breast fed.

“Since there were no reported cases of breast-fed children having received regular vitamin D (400 IU/d) from birth who developed rickets, the current guidelines for rickets prevention can be effective but are not being consistently implemented,” the study concluded.

Adequate vitamin D levels in the blood are important because the body can’t absorb dietary calcium without vitamin D, so in its absence it steals calcium from the bones, which increases the risk of rickets, osteoporosis and fractures.

This also places teenagers at risk because they have weaker bones that are more likely to fracture.

Children at particular risk include infants who are breast-fed exclusively and don’t receive supplementation, children who use sunscreen in summer, children who don’t use sunscreen in the summer but spend less than 15 minutes a day in direct sunlight, children who receive no supplementation in the winter, and children with chronic diseases that affect fat malabsorption, such as cystic fibrosis or celiac disease, according to the Hospital for Sick Children.

TORONTO (Reuters) - The human body is an amazing factory, with all kinds of parts working together to the make the chemicals necessary for good health. But one thing it can’t make on its own is vitamin D. Research shows that defect can be troubling, especially among children.

To create vitamin D, which plays an important role in bone health and development, the body needs exposure to sunlight. As we move into autumn, the days get shorter and colder and our exposure to sunlight decreases, making the colder months of the year a crucial time to watch vitamin D intake. Supplements can play an important role but one question is, how much?

Most of a child’s bone mass is built up early. A vitamin deficiency can prevent a child from building adequate bone mass now, and they won’t be able to make it all up later. Although a study released this week found that vitamin D deficiencies are common in children around the world, there is minimal data on how much supplementation is necessary or safe.

Vitamin D is a fat-soluble vitamin directly or indirectly involved in several key body processes: regulating calcium and phosphorus levels in the blood, promoting bone formation and mineralization, restricting parathyroid hormone secretion and promoting anti-tumor activity. A review of medical literature on the vitamin published last year in The New England Journal of Medicine found that vitamin D is also associated with a reduced risk of type 1 diabetes in children, and may inhibit future hip fracture.

The main source of vitamin D is sunlight, which the body uses to convert vitamin D into a useable form. It’s also found naturally in eggs and fatty fish like salmon or tuna, and milk and some breakfast cereals are fortified with the vitamin. The Institute of Medicine recommends that children get 200 IUs of vitamin D daily, but some experts say that up to 800 IUs is better.

This week’s study found that high doses of the vitamin were safe for children, whether taken over the short-term or for a longer period of time, and helped increased bone mass in 10-17-year olds.

Vitamin D deficiency is particularly a problem for North Americans, research shows, due in part to the higher latitudes at which they live. As well, because of concerns about skin cancer, many people now wear sunscreen, which inhibits the body’s ability to use sunlight to make the vitamin. The Hospital for Sick Children in Toronto says that sunscreen with an SPF above 8 blocks all vitamin D production through the skin. And darker-skinned individuals living in Canada and the United States may be at particular risk because they have more melanin in their skin, which means they need more sunlight than a lighter-skinned person to make the same amount of vitamin D.

A study released this summer found that even children who are otherwise healthy can have low levels of vitamin D, and resulting low levels of bone mineral content. More than 12 percent of the 400 kids studied by researchers at the Children’s Hospital in Boston had levels of vitamin D in their blood low enough to qualify them as deficient, and 40 percent of the children had less than the recommended level
The risk for low vitamin D levels begins in infancy - breast milk, like cow’s milk, is naturally low in vitamin D. And if a mother doesn’t have enough vitamin D, her breast milk won’t either.

A vitamin D deficiency can affect bone growth even if there are no obvious problems. The American Academy of Pediatrics says that rickets (), bone softening that can lead to fractures and deformity, in infants due to low vitamin D intake is seen in several U.S. states. The agency recommends that breast-fed infants receive vitamin D supplement drops.

“It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IUs of vitamin D per day beginning during the first 2 months of life,” said a clinical report for the health agency done by Drs. Lawrence Gartner and Frank Greer. “In addition, it is recommended that an intake of 200 IUs of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual.”

The risks to bone health don’t end in infancy. A Canadian study released last year found that despite guidelines for its prevention, vitamin D-deficiency rickets in childhood is still seen in the country, with an annual incidence of 2.9 cases per 100,000. Children living in the northern part of the country, where exposure to sunlight is the lowest, had the highest incidence, and most of the affected children had medium to dark skin tones and had been breast fed.

“Since there were no reported cases of breast-fed children having received regular vitamin D (400 IU/d) from birth who developed rickets, the current guidelines for rickets prevention can be effective but are not being consistently implemented,” the study concluded.

Adequate vitamin D levels in the blood are important because the body can’t absorb dietary calcium without vitamin D, so in its absence it steals calcium from the bones, which increases the risk of rickets, osteoporosis and fractures. This also places teenagers at risk because they have weaker bones that are more likely to fracture.

Children at particular risk include infants who are breast-fed exclusively and don’t receive supplementation, children who use sunscreen in the summer, children who don’t use sunscreen in the summer but spend less than 15 minutes a day in direct sunlight, children who receive no supplementation in the winter, and children with chronic diseases that affect fat malabsorption, such as cystic fibrosis or celiac disease, according to the Hospital for Sick Children.

Because natural sources are so rare, it’s difficult to get adequate vitamin D in the diet. One tablespoon of cod liver oil has 1,360 IUs, a serving of cooked salmon has 360, a cup of fortified milk has 98 and a whole egg has 20. Fifteen minutes of direct sunlight is enough for many people to reach their needs for vitamin D, but darker-skinned people need longer exposure and because winter sunlight in North America is indirect, supplementation may be recommended.

Do you supplement with extra vitamin D? Let us know: HealthMatters@reuters.com

Unalaska has many great things to offer, but intense sunlight is not one of them. Although the lack of powerful sun may be good for reducing our skin cancer risk, it is not good for our vitamin D levels. The body uses sunlight to make vitamin D from molecules in the skin. Many who live at northern latitudes, especially in the winter, have inadequate vitamin D levels. A study in the British Medical Journal estimates at least 1 billion people worldwide are vitamin D deficient.

Most tissues in the body have receptors for this important vitamin. All of its many functions are still being discovered. The primary role of vitamin D is maintaining normal blood levels of calcium and phosphorous. Long term vitamin D deficiency leads to rickets in children and a softening of the bones in adults.

Currently there is much research being done to discover the additional effects of vitamin D in our bodies. A recent study published in the journal Dibetologia suggests that vitamin D may play a role in preventing type 1 diabetes in children. Vitamin D deficiency has been associated with increased risk of cardiovascular disease, according to a 2008 article in the journal Circulation.

A 2007 article in the New England Journal of Medicine states that people who live at higher latitudes who have vitamin D deficiency, or lack exposure to the sun, have an increased risk of many cancers. The same article suggests vitamin D may also provide protection from hypertension, psoriasis, several autoimmune diseases (including multiple sclerosis and rheumatoid arthritis) and reduce the incidence of fractured bones.

Make sure that you are getting enough vitamin D. It is difficult to get enough from the sun in the summer in Unalaska and impossible in the winter. Check out this Web site from the Norwegian Institute for Air Research to calculate how much vitamin D you are getting from the sun based on your location, weather, skin color, and clothing: http://nadir.nilu.no/~olaeng/fastrt/VitD_quartMED.html.

Obtaining adequate levels of vitamin D from your diet is not easy either. Good dietary sources include fortified milk, eggs, and fatty fish. Some studies, such as one published in the European Journal of Clinical Nutrition last year, have shown that the vitamin D fortification of milk products is not adequate to prevent vitamin D deficiency.

Infants who are breast fed are at particular risk vitamin D deficiency according to a 2004 study published in the American Journal of Clinical Nutrition. Human milk contains little vitamin D, and women who are vitamin D deficient provide even less to their breast-fed infants.

There are differing opinions on the recommended daily intake, especially in light of new studies coming out every day. The USDA recommended daily intake is 400 IUs for a healthy adult. Some physicians recommend much more than that, particularly for those deficient in the vitamin. Because vitamin D can be stored in our bodies, there are high dosages available that can be taken only once a week or once a month.

A 2003 study published in the Journal of Pediatrics looked at the vitamin D levels of women and infants in Alaska. Based on this study, the American Academy of Pediatrics recommends a universal supplement for all infants not receiving vitamin D fortified milk. Talk to your health care provider about getting the right amount of vitamin D for your health.

Tiffany Kelly is medical student from the University of Washington who visited Unalaska for the month of July, 2008. She now lives in Anchorage.

Scientists reporting in this week’s New England Journal of Medicine say that iron deficiency is not the chief cause of severe anemia, a life-threatening anemia in children, and that the condition is often mistaken for other diseases, resulting in unnecessary suffering and death. VOA’s Jessica Berman has more.

Severe, life-threatening anemia, in which oxygen-carrying red blood cells fall to dangerously low levels, often accompanies a number of serious illnesses.

Experts say that in many cases of severe anemia, blood transfusions are needed. When blood is not available or when there are less serious cases, doctors commonly treat patients with iron supplementation.

But an international team of researchers studying children in Malawi found that iron supplementation may not be the appropriate treatment.

“I think the main surprising finding from our study is that iron deficiency is not associated with severe anemia. So, I think giving iron really might be something to reconsider,” said Job Colis, a pediatrician at the University of Amsterdam in the Netherlands.

Colis and colleagues studied 381 severely anemic preschool children in both urban and rural settings in Malawi to try to identify the causes of their condition.

Researchers found that iron deficiency was in fact only responsible for a small number of cases of severe anemia, while the main causes were low-level blood infection known as bacteremia, infection with hookworm and vitamin B deficiencies. According to the study’s authors, one in three children suffered from vitamin B12 deficiency.

Colis believes many anemic patients receive the wrong treatments because their symptoms mimic other diseases, such as malaria, and that they die as a result of the anemia.

Colis wants to see if it’s possible to successfully treat severely anemic patients by giving them what he believes are appropriate treatments. “I think the next step forward would be to actually try these interventions to give children supplementation with vitamin B-12 or to treat bacteremia and to see if it actually prevents them from becoming severely anemic,” he said.

The World Health Organization recommends treating severe anemia with iron supplementation, folic acid, which is a water soluable, B9 vitamin, and zinc. Except for iron, the study did not find that deficiencies in these supplements caused anemia in the childlren.

At best, Colis believes the WHO guidelines are lacking. “On the other hand, there are other interventions that you really need to question if it’s worth the effort and actually might be dangerous, for example, give iron to these children,” he said.

Without knowing what’s causing the anemia, Colis says it’s easy to give too much iron, which is toxic.

Meanwhile, investigators plan further research on the treatment of severe anemia in children hoping to provide evidence that will lead to revisions to the WHO guidelines.

By Darwin Danielson

While the cold winter weather may put you in a bad mood and keep you indoors, one group says it can also have an adverse health impact. Tim Miller is a spokesman for the U.V. Foundation and says many people in Iowa and other Midwestern states aren’t getting enough sunlight.

Miller says that results in vitamin D deficiency, which he says can lead to increased risk for colon, prostate and breast cancer, M.S. and an increase in children reporting rickets. Miller says there are a lot of remedies including supplements and tanning beds. He says the recommended level of vitamin D is one-thousand units per day.

He says you can look on the side of the supplement bottle to see how much that is. Miller says one serving of salmon has 900 units, so that would cover a day. One glass of milk is 400 units, and five to seven minutes twice a week in a tanning bed would cover the need.

Miller says supplementing you vitamin D intake is important in the winter months, then you must also be sure to get some sunlight in the spring. Miller says you need 15 to 20 minutes of exposure in the sun before you put on your sunscreen.

Miller says a recent study released by Boston University School of Medicine, found that people living in Iowa and other northern latitude states are 74-percent Vitamin D deficient during the month of February. And a Harvard Medical School study published in the New England Journal of Medicine has reported that 60-percent of Americans are vitamin D deficient.