Free vitamin program in the United Kingdom is not providing enough vitamin D

Posted on: January 27, 2015   by  John Cannell, MD

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Recently, researchers from the UK documented the administrative nightmare in the UK concerning distribution of “Healthy Start” vitamins for pregnant women, infants and children.

McFadden A, Green JM, McLeish J, McCormick F, Williams V, Renfrew MJ. Healthy Start vitamins-a missed opportunity: findings of a multimethod study. BMJ Open. 2015 Jan 8;5(1):e006917. 

It appears that more than 95% of the cost of Healthy Start vitamins is administrative. However, their paper left me with the question of what exactly is in Healthy Start vitamins?

The vitamin supplements for women contain:

  • 70 milligrams of vitamin C
  • 10 micrograms (400 IU) of vitamin D
  • 400 micrograms of folic acid

A dose of 400 IU/day of vitamin D in “Healthy Start” vitamins is so low that the same dose used by the Women’s Health Initiative resulted in 57% of the women still having 25(OH)D below 20 ng/ml.

Millen AE, et al. Predictors of serum 25-hydroxyvitamin D concentrations among postmenopausal women: the Women’s Health Initiative Calcium plus Vitamin D clinical trial. Am J Clin Nutr. 2010 May;91(5):1324-35.

The literature shows pregnant women and breastfeeding women should take at least 4,000 IU/day. Our current recommendation for pregnant women and breastfeeding women is to take 4,000- 6,000 IU/day.

Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011 Oct;26(10):2341-57.

The vitamin supplement for children contains:

  1. 233 ug (776 IU) of vitamin A
  2. 20 mg of vitamin C
  3. 7.5 ug (300 IU) of vitamin D

The preformed retinol daily dose of 776 IU/day is not toxic.

Penniston KL, Tanumihardjo SA. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006 Feb;83(2):191-201. Review.

However, Healthy Start recommends the same dose of vitamin D3 for a 5-pound infant as a 50-pound child. Does that make any sense? According to the Endocrine Society, the correct daily dose of vitamin D3 for children is higher than 300 IU/day and is, sensibly, based on body weight.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.

For infants and children, the Vitamin D Council recommends 1,000 IU/day of vitamin D3 for the first year of life and then 1,000 IU/day for each 25 pounds of body weight for children one year or older. So a 75-pound child aged 8 years old would take 3,000 IU/day.

The Healthy Start program is hopelessly immured in governmental regulations and bureaucracy.  The dose of vitamin D for pregnant women is not high enough. The vitamin D dose for infants is better, but still inadequate. The dose for older children is not based on body weight, which should always be considered when making recommendations for daily doses of vitamin D.

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