CHEP Tuesday January 27 th 10 a m

CHEP Tuesday January 27 th 10 a. m. - noon Mayfair United Church 33 rd Street at Avenue I. Saskatoon

My Story Nurse Mom Spouse Business person

The Ddrops Story What is Ddrops? • Ddrops is vitamin D 3 in pharmaceutical quality, thin vegetable oil, distilled to remove the parts of the oil that can go bad or that have any taste. • Approved through Health Canada NPN and manufacturers by accredited facilities • Vitamin D 3 is also known as Cholecalciferol, produced from sheep’s wool lanolin • Ddrops is packaged in a very different style from other vitamin D’s. It takes only a little getting used to, with a Eurodropper that works automatically to let a drop fall by itself.

Why is vitamin D important? KIDNEYS Use vitamin D to make a hormone that turns on the ability to absorb Calcium from food, including from breast milk. Without vitamin D, the protein part of bone is made, but it doesn’t get enough calcium to get hard rickets MANY OTHER PARTS OF THE BODY NEED VITAMIN D MUSCLES Even before a baby has rickets, lack of vitamin D results in weak muscles. Sometimes called, “weak, floppy crying baby syndrome”. IMMUNE SYSTEM The immune system needs vitamin D to develop properly, a lack of vitamin D early in life seems to increase risk of autoimmune disease like diabetes and multiple sclerosis. NEONATAL IMPRINTING The conditions of the newborn period establish characteristics that can remain for life.

Why give Babies Vitamin D? Why risk? • Muscle weakness happens before rickets • Weak, floppy crying baby syndrome (due to muscle pains) • Rickets • Immune Defects • Risk of infections (weak muscles plus immune problems results in higher rates of childhood pneumonia) • Future bone health – long term bone strength • Future health: diabetes, multiple sclerosis and cancer

The Childrens’s story HEIDI Her friend Clara who lived in the city probably suffered from • • • Rickets Weak muscles Infection-prone Probable serum 25(OH)D < 25 nmol/L She regained her health after time in the mountains with Heidi: CURED BY THE SUNSHINE VITAMIN! Probable serum 25(OH)D >75 nmol/L

Rickets is still around, and it is not something we have finished dealing with

Interpretation: Vitamin D–deficiency rickets is persistent in Canada, particularly among children who reside in the north and among infants with darker skin who are breastfed without appropriate vitamin D supplementation. 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 exception appears to be infants, including those fed standard infant formula, born to mothers with a profound vitamin D deficiency, in which case the current guidelines may not be adequate to rescue infants from the vitamin D-deficient state.

Finnish 1966 -birth cohort: Vitamin D to the babies prevented diabetes by 1996 when they were age 30 yrs Babies who received vitamin D ended up by age 30 years, with only ONE FIFTH THE RISK OF TYPE 1 DIABETES =2000 IU/d Hyppönen et al 2001 Lancet 358: 1500– 03

Paediatric Societies everywhere recommend vitamin D for Babies.

September 2007 Canadian Paediatric Society 400 IU from birth onwards

NEW NOVEMBER 2008 VITAMIN D REPORT American Pediatric Association 400 IU from birth onwards

In Britain: “The only vitamin for which there is strong evidence of clinical deficiency in the UK”

Why do many moms not give their children vitamin D?

An Internet Survey found that very few moms gave vitamin D

Survey Results "Do you or Did you give your breastfed Little One vitamin D drops? " 80% 70% 60% 50% 40% 30% 20% 10% 0% NO, and LO is fine YES! Sometimes No, and LO has rickets

Why no to vitamin D? • • I don't bother, it is not needed. • Both kids are fine despite never having had a supplement. • Take the kids outside every day. I am not worried about it. • Baby's cot next to a window so when he is there I open up the blinds to let the sun go through. Didn't use them with any of the children and we had no problems.

The thinking for NOT using vitamin D is no different than the following: I don’t need a bike helmet, because I don’t fall off my bicycle I don’t need a smoke detector, my house isn’t on fire Its alright to smoke, I’m healthy now I don’t need car insurance, I’ve never been in an accident/crash

Options for vitamin D – 400 IU 1. 2. 3. 4. The old way Expose skin to sunshine in the summer Cod-liver oil – 1 tsp Traditional “Liquid vitamin D”/Di-Vi-Sol® style – 1 m. L Drop of oil onto nipple while breastfeeding – 1 drop The new way

If your shadow is taller than you are then you cannot make vitamin D (UV index = 3)

Pregnancy and Vitamin D

Dose-response association between maternal serum 25 -hydroxyvitamin D concentration at less than 22 wk gestation and the risk of preeclampsia. Bodnar et al. • J Clin Endocrinol Metab, September 2007, 92(9): 3517– 3522 3521 “a 50 -nmol/liter decline in 25(OH)D concentration doubled the risk of preeclampsia” 25 (O H )D Logistic regression model (P= 0. 02). The solid line represents the point estimate, and the dotted lines represent the 95% confidence bands.

Bone mineral conten at age 9 To raise a Mother’s 25(OH)D by 50 nmol/L requires about 50 mcg/day of vitamin D 3. Bone mineral density at age 9 Serum 25(OH)D nmol/L During Pregnancy Javaid et al. Lancet 2006; 367: 36– 43