In response to Health Canada finalizing the revision of its vitamin D policy for Canadian infants, INFACT Canada wrote to Health Minister Ujjal Dosanjh.  We urged him to reconsider the controversial recommendations that all breastfed infants be given a daily supplement of 400 IU of vitamin D from birth.

    INFACT Canada’s concerns are that:

■  the policy is not based on adequate scientific data,

■  there is no scientific data offered that all breastfed infants are at risk,

■  population surveys of Vitamin D adequacy easily identify those who need counseling and intervention.

■  there is no evidence offered that the recommendations are safe,

■  alternatives and preventive measures are not included in the recommendations,

■  there is significant conflict of interest in data used and researchers involved.

Who Benefits?

    Not surprisingly, the primary beneficiaries of this policy will not be Canada’s infants, but the very same industry that violates Canada’s Food and Drugs regulations and Industry Canada’s Competition Act with misleading labelling and claims as well as violating the World Health Organization’s rules on the marketing of infant formulas.

    Our letter requested that Minister Dosanjh review this controversial vitamin D policy.

    For the full text of INFACT Canada’s letter to Mr. Dosanjh, click here.

Many questions remain regarding the implementation of the vitamin D recommendation.

1. Why are the manufacturers of the supplement not mandated to include warnings about appropriate use and symptoms of toxicity?

2. The Health Canada policy statement notes that the Upper Tolerable Limit for vitamin D for infants to the age of one year is 1000 IU.  Newborn infants are approximately one third the weight of a one-year-old.  Should the Upper Tolerable Levels be the same for newborns as they are for 12 month-old infants?

3. How is it that the product insert – see graphic - has advertising for the Mead Johnson infant formula but not health warnings about potential toxicity?  As one INFACT member commented, "This is so wrong!"

4. How is it that Mead Johnson is using hospital-based marketing to push free samples of its vitamin D product with the offensive formula promotions inserted?  This is a clear violation of the International Code.

5. Although approximately 90 per cent of infants initiate breastfeeding, there is a very rapid decline in exclusivity after hospital discharge.  Approximately 50 per cent begin supplementation supplementation during the first month¹ and after one month about 20 per cent stop breastfeeding altogether.  Why are there no recommendations for parents to reduce or discontinue the vitamin D supplements to reflect these practices?

6. What are the risks of overdosing?  Many parents would be inclined to think that a little extra for good measure might be beneficial and yes indeed the vitamin D dropper does have the greater capacity for that "little extra."

7. Vitamin D toxicity – what are the symptoms?  Vitamin D is a powerful hormone, that is also fat soluble and therefore able to accumulate in fatty tissue.  Excess vitamin D leads to increased absorption of calcium from the infant gut and through bone calcium re-absorption.  High calcium levels cause general symptoms such as loss of appetite, vomiting, polyuria, dehydration, failure to thrive and irritability.  Will these symptoms trigger concerns about hypervitaminosis?

8. How is it that a Canadian Pediatric Society survey² which identified only 69 cases of rickets over a time period of 18 months and included all children from 0 to 18 years of age is used as a basis to frighten parents and health care workers into thinking we have a health problem?  As well these cases include all those with low serum 25-hydroxyvitamin D (25OHD and those with elevated serum alkaline phosphatase.  Moreover, the survey received partial funding from Mead Johnson and one of the major researchers is a consultant with Mead Johnson and Nestlé.  Why is it that inadequate breastfeeding is not seen as a far greater health risk?  In Canada it is anticipated that at least 72 infants die during their first year of life because of formula feeding.

References

1. Kassam-Lallani D. et al. Exclusivity of Breastfeeding: Halton Region Health Department. June 2002 [Return]

2. Canadian Pediatric Society. Canadian Pediatric Surveillance Program 2003 Results. Canadian Pediatric Society. [Return]