We all know that a good, balanced diet of protein, fruits, vegetables, and grains eaten each day in recommended serving sizes, is capable of providing our bodies with essential vitamins and nutrients. These elements are the foundational fuel that we need to ensure that our bodies function as they are intended; they make us capable of healing and fighting off foreign invaders or diseases we sometimes encounter. Their names are familiar to us—A, B, C, D, and E—a virtual alphabet of essential ingredients to keep our bodies operating at their full potential. Recently there are certain vitamins that, through further scientific study, have come to the forefront of public knowledge due to news about their increased or more clearly understood benefits. Such is the case with vitamin D.

According to the National Institutes of Health's Office of Dietary Supplements (ODS), vitamin D is a fat-soluble vitamin that is naturally preset in very few foods, but is added to others and is also available as a dietary supplement. Your skin also produces vitamin D when it is struck by the sunlight's ultraviolet rays.

The ODS adds that vitamin D plays a vital role in promoting the body's absorption of calcium, which is necessary for bone growth and replenishment. An insufficient amount of vitamin D can lead to soft bones and rickets in children and a condition called osteomalacia in adults (the adult version of rickets). Combined with calcium, vitamin D is responsible for protecting older adults from bone loss leading to osteoporosis. Vitamin D also plays additional roles in health including a role as a vital link in the neuromuscular and immune systems as well as an aid in the reduction of inflammation. The Mayo Clinic also notes that recent research suggests that vitamin D may also provide protection from cancer, hypertension (high blood pressure), and several autoimmune diseases.

Vitamin D is difficult to obtain naturally in foods. The ODS notes that the following foods are good sources, but few are high on a child's list of favorite foods:

• Cod liver oil
• Salmon
• Mackerel
• Tuna fish
• Sardines
• Milk, nonfat, reduced fat, and whole, vitamin D-fortified
• Margarine (fortified)
• Ready-to-eat cereal (fortified)
• Eggs (the yolk contains vitamin D)
• Liver, beef
• Swiss cheese

The ODS states that most people acquire their vitamin D needs through exposure to sunlight. However, many variables such as the skin's melanin level, time of day, season, geographic latitude, cloud and smog cover, and sunscreen use can reduce the skin's ability to absorb and process the UV radiation into vitamin D. The simple variable of where you live has a significant impact on your possible exposure to the right amount of sunlight. According to the ODS, the ultraviolet energy above 42 degrees north latitude (imagine a line running between the northern border of California and Boston) is an area that is insufficient for the skin to process vitamin D from sunlight from November through February. Ever further north, this reduced intensity lasts for six months. For those living in areas lying below a line between Los Angeles and Columbia, South Carolina, the intensity of sunlight is sufficient for vitamin D production year-round. Additionally, cloud cover reduces UV energy by as much as 50% and severe pollution can reduce intensity by 60%. Sunlight's UVB radiation does not penetrate glass, so exposure to sunlight indoors will not produce vitamin D. Sunscreens with a sun protection factor (SPF) higher than 8 will also block the needed UVB radiation.

Infants and children are those most at risk for suffering from a vitamin D deficiency. The American Academy of Pediatrics (AAP) recommends giving vitamin D supplements to infants who are breastfed, since human milk does not contain enough vitamin D to prevent rickets. The AAP notes that supplemental vitamin D for infants is available as liquid vitamin drops (often in combination with vitamins A and C). Babies should be given the recommended amount from the dropper beginning in the first 2 months of the baby's life. The AAP notes that vitamin D drops should be given until a child has been weaned from breastfeeding and is receiving at least a pint (16.9 ounces) of infant formula each day. The AAP also notes that, "infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula." Additional vitamin D supplements can cease once a child begins drinking at least a full pint of vitamin D-fortified milk after 12 months of age. If an older child drinks less than 17 ounces of regular milk, he or she should be given supplemental vitamin D in the form of drops or a tablet.

Babies who are fed infant formula are taking in vitamin D, as the AAP notes that all formulas sold in the United States have a sufficient amount of supplemental vitamin D as long as they are given about 16.9 ounces (a pint) of infant formula each day.

But how much is enough? In 2008, the AAP issued a new set of recommendations for vitamin D intake for infants, children, and adolescents. The AAP recommends that exclusively and partially breastfed infants should receive supplements of 400 IU/day (International Units) of vitamin D shortly after birth and continuing until they are weaned and consume more than 1,000 mL/day of vitamin D-fortified formula or whole milk. All non-breastfed infants receiving less than 1,000 mL/day of vitamin D-fortified formula or milk should receive a vitamin D supplement of 400 IU/day. Older children and adolescents who do not receive 400 IU/day through vitamin D-fortified milk and foods should also take a 400 IU vitamin D supplement daily.

An early start to building strong bones is a vital part of raising a healthy child. By learning more about the role vitamins such as vitamin D play in how the body functions and making sure your family members receive their essential vitamins through a healthy diet and vitamin supplements, you'll be doing everything possible to put them on the road to a strong body and strong mind!

As with any health issues, consult with your family physician, pediatrician, nutritionist, or health care provider regarding any nutritional, dietary, or supplemental vitamin questions.

Sources:
Mayo Clinic—www.mayoclinic.com
American Academy of Pediatrics—www.aap.org
Office of Dietary Supplements—www.ods.od.nih.gov

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