BREASTFEEDING MEDICINE Volume 3, Number 4, 2008 Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2008.

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Editorial

Tackling Critical Issues for Breastfeeding: Vitamin D and Environmental Toxins

Ruth A. Lawrence

HEN CHALLENGED TO SPEAK on the question Does Vitamin D Make the World Go Round? at the Academy of Breastfeeding Medicine annual meeting in 2007, Dr. Carol Wagner answered with an outstanding review of the role of vitamin D in health and disease. We urged her to record her remarks for publication and are delighted to publish those remarks plus a few additional thoughts and an extensive bibliography in this issue of the journal. Vitamin D is a hormone, not a vitamin, and it is not just for kids any more. Dr. Wagner points out that it is more than about calcium metabolism, and in fact it is critical to the function of the immune system. It is highlighted that vitamin D is the only steroid hormone system that is limited by substrate availability. The review explains the function of the role of vitamin D from absorption and sunlight synthesis and in metabolism. The storage potential is explained as well as dietary resources. Probably the most startling information is that adults are commonly in deficit in modern society and, furthermore, that vitamin D deficiency is associated with multiple sclerosis, rheumatoid arthritis, tuberculosis, diabetes, malignant melanoma, and other cancers. The normal values are discussed as well as toxic levels. So what does this have to do with breastfeeding? Well, breastfed infants may be in deficit because their mothers are deficient and infants are not exposed to sunlight any more. The ultimate solution for this breastfeeding dilemma is described, as Dr. Wagner explains the research in progress using high doses for the mother. Thus, the answer to the question Does vitamin D make the world go round? is: not entirely, but it certainly helps. This issue of the journal covers a wide variety of essential clinical issues that impact the advice practitioners give their mothers about breastfeeding. No subject, however, has raised more concerns and precipitated more publications than that of environmental toxins in breastmilk. The

article The Heart of the Matter on Breastmilk and Environmental Chemicals: Essential Points for Healthcare Providers and New Parents is authored by Judy S. LaKind of LaKind Associates, Cheston Berlin, M.D., eminent scholar on the subject at Hershey Medical Center at Penn State College of Medicine, and Donald Mattison, M.D., who is a member of the U.S. Public Health Service and a member of the Pharmacology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This trio has long been involved in the issues of environmental toxins. The goal of their article is to present all that is known about the subject using the data about dioxins as a case study of a common environmental toxin. They make the distinction between a concentration of chemicals in breastmilk and subtle effects on infants that signal the need for further study or regulatory action and changes seen in an individual case that may not be considered significant. Terms are defined for the non-chemist, and the rationale for monitoring breastmilk as a public health mechanism for designing regulations is explained. Many have been alarmed by reports in the popular press of breastmilk toxin levels in various geographic areas. These reports reflect the federal effort to monitor levels in a population and not a concern about mothers milk. The authors conclude that even in times when toxin levels are high (as in the case of dioxins they describe) beneficial effects associated with breastfeeding have been found. This is reassuring, although the reader may find it rather lukewarm. Readers could, in fact, comment with a letter to the editor. . . . . . . . . . Go ahead, make my day! Ruth A. Lawrence, M.D., FABM Editor-in-Chief

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