By Dr. Ben Head
For The Cordova Times
An adequate level of vitamin D in the body is widely known to be crucial for good bone health in people of all ages. However, increasing evidence shows this is especially true during pregnancy and in newborns and even more so for people living in Alaska.
Vitamin D, dubbed “the sunshine vitamin,” is a fat-soluble vitamin produced by the interaction of UV light from the sun with our skin. It is also found in many traditional foods, such as salmon, herring and tuna. In fact, wild sockeye salmon is considered one of the best sources of naturally occurring vitamin D in the world. A 3.5-ounce fillet contains around 600 international units, or IU, which is the recommended daily amount for the average American. Interestingly, the same size fillet from a farmed salmon contains only 25%-50% as much. Vitamin D helps to regulate the absorption of calcium which is needed for bone growth, maintenance and repair. Vitamin D deficiency can lead to osteomalacia — softening of the bones — in all adults, osteoporosis in the elderly and rickets in children.
National guidelines
According to the Food and Nutrition Board at the National Academies of Sciences, Engineering and Medicine, all newborns who are strictly breastfed should consume 400 IU of Vitamin D. Breastmilk contains no vitamin D. All children and adults aged 1 through 70 should consume 600 IU and everyone over age 70 should be taking in 800 IU daily. These numbers are total vitamin D daily from all sources including sunlight, diet and supplements.
Vitamin D deficiency in pregnancy
Gynecologic societies have long supported vitamin D supplementation in pregnancy. However, evidence was lacking until 2019 when a Cochrane Review update including 30 research studies and over 3,700 pregnant patients showed a probable link between vitamin D deficiency and low birth weight, risk for developing pre-eclampsia, gestational diabetes and increased bleeding after delivery. They suggest that the 400 IUs found in a standard prenatal vitamin may not be sufficient, especially in higher risk populations.
Alaska-specific guidelines
Alaskans are a higher-risk population. The winters are dark and the summers are cool, so even when the sun is shining we tend to bundle up more than our friends further south. The sun is also typically at a lower angle in the sky, so many of the UV rays are filtered out by Earth’s atmosphere before reaching our body. While this makes for radiant, youthful skin later into life, it is also the perfect setup for vitamin D deficiency. According to the Alaska Division for Public Health, Alaska Native children under the age of 10 had nearly twice the national rate of rickets-associated hospitalizations. In 2016 an international panel of healthcare workers and other experts, the Alaska Vitamin D Workgroup, was assembled to combat this alarming trend. In 2018 this group released recommendations that all pregnant ladies in Alaska should be taking in an additional 1,000 IUs daily through diet and supplements in addition to their normal prenatal vitamin. Infants that were solely breastfeeding should double the national recommendation and be supplemented with vitamin D 800 IU daily. Even infants receiving vitamin D fortified formula should still be supplemented with an additional 400 IU daily. The rest of the population should continue with standard national recommendations. No clear evidence exists for standard screening and monitoring intervals of vitamin D levels. However, it seems reasonable that anyone on vitamin D supplementation should be tested one to two times a year.
The bottom line
Sufficient vitamin D intake is essential for everyone, but especially vital for pregnant mothers and their children, before and after delivery. Here in Cordova we are fortunate that whatever sunshine we may lack is made up for in our access to salmon to help us reach our daily requirement of vitamin D.
- Pregnant ladies: Vitamin D 1,400 IU daily
- Infants under 1: Vitamin D 800 IU daily
- Others aged 1-70: Vitamin D 600 IU daily
- Those over age 70: Vitamin D 800 IU daily
Always consult with your physician before starting, stopping or changing the dose of any medication.
Dr. Ben Head is medical director for Ilanka Community Health Center.
