A pair of substantial mammary glands have the advantage over the two hemispheres of the most "learned"... brain

I spend a lot of time in doctor's offices, and thus have spent a lot of time reading magazines (although I generally do try to have a book handy).  Every now and then a magazine or article will catch my eye.  As a new mom, I came across a local monthly, Washington Parent, touting itself as "The Trusted Source for Parents in DC, MD & VA."  It didn't take me long to stop reading it, though.  Why?  For one, it's not much more beyond a book of advertisements, mostly for local businesses and events.  Nothing particularly wrong with that, but it wasn't exactly something I found useful.  Then there's the fact that their "special" issues, discussing things like local camps and the "best" local schools, only feature companies or organizations that advertise with them.  It's the way of the business world, I get that, but again, not particularly useful.

But the single biggest reason?  Their articles.  The articles are just regurgitations of old news repackaged.  For some parents that may be helpful, but for me, I just didn't need to waste my time reading the same things I'd already read at the source.  Especially when the source articles aren't condensed and riddled with the opinions of the magazine staff.  Specifically, I found myself balking at articles regarding breastfeeding, co-sleeping, or other Attachment Parenting style techniques.  Not just because I disagreed with them, but because they were often filled with misinformation, if not clearly biased in their disfavor.

For some reason I picked up their latest edition.  Can't remember why.  Decided to flip through it a bit, see if I could figure out what must have caught my eye.  On page 68 is an article entitled "What?  I Need More Vitamin D?"  It is about pediatric recommendations for Vitamin D supplements.  The topic isn't a new one and the article contained no new information.  In fact, the topic has only been mentioned in any news sources over the last few years because the recommended dosages have been slightly adjusted.

The more I read of the article, the more irritated I became.  First, there is the large, prominent picture in the center of the page.  Cute baby, pretty eyes.  Big-ass bottle.  Now, Washington Parent isn't littered with formula ads and they aren't filled with bottle-fed baby pictures.  That doesn't mean, however, that they don't get their prevailing opinion across one way or another.  If you didn't think that the picture was enough, the very wording of the article itself makes sure that you get their point.  And then they hammer it home, starting the article with:

"Breast is best, but as more mothers are breastfeeding, the risk for vitamin D deficiency rickets has increased for all children."

Oh really?  That's a fact, eh?  And where exactly are they getting that information?  Thing is, they don't actually say!  WP cites two individual studies, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents" and "Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease and osteoporosis."  The second article doesn't even mention breastfeeding, and the first one doesn't, in any way shape or form, blame breastfeeding for increased cases of rickets.  But I'll get to that in a minute.  The article continues:

"Human breast milk is another source of vitamin D; however the amount of vitamin D in human milk is extremely low"

Well, sort of.  What the study actually says is:

"Although corollary maternal serum concentrations were not measured, on the basis of vitamin D pharmacokinetics, maternal vitamin D status is assumed to have been abnormally low, thereby preventing adequate transfer of vitamin D in human milk."

In other words, the theory is that, when the mom is deficient in vitamin D, an exclusively breastfed baby will not be able to absorb enough vitamin D to prevent rickets.  Which means that, if a mother is deficient, she will not be able to provide enough vitamin D to the child through breastfeeding alone, but no studies have been done to determine if supplementing the mother will provide enough for the baby through the breastmilk.  Now, the debate comes into play when deciding whether or not a child would actually need a supplement versus merely needing more exposure to the sun, but that's another post altogether.  And we're still not even to the section that ticks me off the most.  Here's the next part:

"Recently, there has been an emphasis on the vitamin D intake of exclusively breastfed infants.  As more infants are being exclusively breastfed, the chances of developing infantile rickets has increased, especially in infants with darker pigmentation."

Where to begin with this?  Let's see...  The specific studies that WP is referencing?  The first is from 2008, the second is from 2004.  That is not "recent."  Mostly, though, the absurd part of this is the statement that the chances of developing infantile rickets increases due to exclusive breastfeeding.  That is, at best, a blatant exaggeration deliberately intended to mislead the readers.  What does the study actually say?

"Rickets attributable to vitamin D deficiency is known to be a condition that is preventable with adequate nutritional intake of vitamin D.  Despite this knowledge, cases of rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continue to be reported in the United States and other Western countries, particularly with exclusively breastfed infants and infants with darker skin pigmentation." 

In other words, rickets is preventable with enough vitamin D intake.  However, rates of rickets are increasing because children still aren't getting enough vitamin D through both nutrition and sun exposure.  When taken *in context* with the rest of the study, the meaning is a bit clearer: children who are exclusively breastfed by mothers who are deficient in vitamin D are more likely to develop rickets if they are not absorbing enough vitamin D through sunlight exposure (which is more likely when the child has darker skin).  However, if a child is receiving food fortified with vitamin D (e.g. formula), they are not as likely to be deficient, excluding sunlight absorption.  Even that isn't what upset me the most, though.  It was this:

"Breastfeeding puts all infants at risk for vitamin D deficincy due to the poor vitamin D status of most lactating mothers and the inadequate amounts of vitamin D that is transmitted via breastmilk(1)." (My emphasis.)

Wow.  Just wow.  They actually put a footnote with that, linking it to the first study.  This claim seemed unbelievable to me.  So I tracked down the study.  Read it.  Tried to find the supporting claim.  And you know why it seemed unbelievable to me?  Because it is unbelievable.  Because the study doesn't say any such thing.  The topic of the study is the increase of the recommended supplemented dosage from 200 IU/day to 400 IU/day.  (Assuming, of course, that the child needs supplements in the first place!)  Nowhere does it say that exclusive breastfeeding puts an infant at risk for a vitamin D deficiency; rather that if you are already vitamin D deficient, you cannot gain enough vitamin D through exclusive breastfeeding alone.  That's not the same thing at all.

This article has to be one of the most irresponsible and misleading pieces of garbage that I've ever read.  I don't know what kind of anti-breastfeeding agenda that author "Christi Hay, M.D. MPH" has, but it's clear that she has one.  Given her inability to understand even the most basic concepts outlined in a scientific study, her poor patient ratings aren't much of a surprise.

Comments

[Gissel]

Misleading indeed. The right advice should be to suplement the mother. As I told you before, most women breastfeed here in Uruguay, even poor women with poor nutrition (yet quite a lot of sun exposure), and there are no cases of rickets.

[jtlitch]

Wow, the fact that a doctor would support anything other than breastfeeding is surprising to me, especially one that is an M.D. I will concede that baby formula has the required vitamin D, but formula comes with its own complications (colic, constipation, increased chances of allergies, incomplete physical development, and so much more). Breast is best, even if for only a couple weeks. Take the kid outside, momma can take vitamin D supplements or baby can take vitamin drops if outside is not possible. The excuses some people make for not breastfeeding is just outrageous and disturbing, when it means a better life for your children, deal with it and pop out the tit!

[The Wife]

Gissel, I've no doubt that rickets has increased (at least slightly) even in Uruguay, but the reasons are related to lack of sun exposure (both mother and child), due to the more sedentary lifestyles that people in developed countries lead. As of now, there have been no studies to determine if a supplement for a mother will provide ENOUGH vitamin D for the child through the breastmilk, so I'm not necessarily opposed to supplementing the child -- but that's only if the child isn't getting adequate sunlight to begin with!

John, doctors are NOTORIOUSLY blasé about breastfeeding. In my experience, female doctors are even worse than male doctors. Why? Well, my theory is that female doctors are more likely to formula feed because of their work schedule (working full time makes exclusive breastfeeding difficult, requiring a LOT of dedication, although it CAN be done). If they convince other moms to make the same choices, then they don't have to feel guilty for taking the easy way out. Male doctors are either very in favor of it, or they figure the decision should be completely up to the woman. It's disturbing. When you think about how uneducated most women are regarding breastfeeding, and how they turn to their doctors for advice, it's no wonder that long-term exclusive breastfeeding rates are so damned poor.