Holick, M. F. (2007). New England Journal of Medicine, 357, 266-281.

This review article of the vitamin D literature revealed an epidemic of vitamin D deficiency in children and adults. Most of us thought that once foods such as milk were fortified with vitamin D, rickets was a disease of the past and we were safe from health problems resulting from vitamin D deficiency. This article shows us, however, that there are startling deficiencies of vitamin D in all age groups, including 32% of healthcare professionals at one hospital. Vitamin D is related to our sunscreen culture, because we are consistently eliminating sun exposure as a good potential source of vitamin D. This article enumerates the sequelae of vitamin D deficiencies, including poor calcium absorption and the fact that vitamin D controls more than 200 genes, some of which are responsible for regulating normal cells and cancer cells. Vitamin D also has been linked with autoimmune diseases, osteoarthritis, diabetes, and cardiovascular disease. Women who are vitamin D deficient provide inadequate amounts of vitamin D to their breastfed infants. So what can be done? Evidence suggests that recommended dietary intakes are actually inadequate and need to be supplemented to levels reaching at least 800 IU of vitamin D per day. Unless we eat oily fish frequently, it is very difficult to obtain enough vitamin D from dietary sources. Sensible sun exposure is also recommended and defined as exposure of arms and legs for 5 to 30 minutes between the hours of 10am and 3pm twice a week, depending on skin pigmentation, latitude, and season. For persons wishing to delve deeper into the synthesis and metabolism of vitamin D in the regulation of calcium, phosphorus, and bone metabolism and nonskeletal functions of vitamin D, detailed diagrams are available. I highly recommend this article for all healthcare professionals interested in health promotion and disease prevention for mothers and infants.

Linda Beth Tiedje