BREASTFEEDING MEDICINE
Volume 3, Number 4, 2008
© Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2008.9989
Editorial
Tackling Critical Issues for Breastfeeding:
Vitamin D and Environmental Toxins
Ruth A. Lawrence
W HEN CHALLENGED TO SPEAK on the question “Does Vit-
amin 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 bib-
liography in this issue of the journal. Vitamin D is a hor-
mone, not a vitamin, and it is not just for kids any more. Dr.
Wagner points out that it is more than about calcium me-
tabolism, and in fact it is critical to the function of the im-
mune system. It is highlighted that vitamin D is the only ste-
roid 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 re-
sources. Probably the most startling information is that
adults are commonly in deficit in modern society and, fur-
thermore, that vitamin D deficiency is associated with mul-
tiple 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 de-
scribed, as Dr. Wagner explains the research in progress us-
ing high doses for the mother. Thus, the answer to the ques-
tion “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 essen-
tial clinical issues that impact the advice practitioners give
their mothers about breastfeeding. No subject, however,
has raised more concerns and precipitated more publica-
tions than that of environmental toxins in breastmilk. The
205
article “The Heart of the Matter on Breastmilk and Envi-
ronmental 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 mem-
ber of the Pharmacology Branch of the Eunice Kennedy
Shriver National Institute of Child Health and Human De-
velopment. 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 be-
tween 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 ef-
fort to monitor levels in a population and not a concern about
mother’s milk.
The authors conclude that even in times when toxin lev-
els are high (as in the case of dioxins they describe) “bene-
ficial 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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