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The politics of vitamin D: questioning universal supplementation. (Breastfeeding)(Cover Story).

Article Excerpt
As early as the spring of 2003, the American Academy of Pediatrics (AAP) may recommend that all breastfed babies receive a daily supplement of vitamin D, based on the belief that breastmilk is deficient in vitamin D and that exclusive breastfeeding can lead to rickets. Such a recommendation is paradoxical: While breastmilk is supposedly the best form of infant nutrition (as mothers, physicians, and even infant-formula companies agree), it is somehow lacking in sufficient amounts of vitamin D. This policy could have far-reaching, potentially harmful implications for the work of breastfeeding advocates across the country, particularly in the African American community.

Rickets

Nutritional rickets is a disease characterized by weak bones, poor bone development, and bowed legs. It is caused by a deficiency in vitamin D. (It can also be caused by cystic fibrosis, metabolic disorders, and celiac disease.) Humans need vitamin D for bone growth and calcium absorption. Our primary source of vitamin D is sunlight, or ultraviolet B (UVB) exposure. Vitamin D is also in such foods as salmon and egg yolks.

Nutritional rickets is rare in the US, though over the past few years there have been new cases around the country. It's so uncommon, in fact, that until recently there was no national monitoring system to track and study the disease; the Centers for Disease Control (CDC)is just beginning to monitor it. Signs of rickets in infants include slow growth, seizures, the inability to stand or walk, curved bones, large joints, and bowed legs. In the 1920s, researchers discovered that the root of the disease was vitamin D deficiency; since then, many foods, including cow's milk, have been fortified with extra vitamin D.

Vitamin D-deficiency rickets is a public health issue that warrants attention, but not at the expense of breastfeeding. Media attention has mainly focused on exclusive breastfeeding as a cause of rickets; however, an increase in rickets cases may result from the reduced amount of time that people...