Your questions about vitamin D (and other supplements) have been answered.

About Nutrition

I got some great questions after my recent column about recent research on vitamin D, so this week I’m answering some of them, along with two additional questions I received about dietary supplements.

Do Babies and Children Still Need Vitamin D Supplements?

Recent research has eroded the idea that most adults should take vitamin D supplements, with exceptions for those with actual deficiencies or certain health conditions, but infants and young children still benefit from vitamin D supplements. in children, vitamin D deficiency causes rickets, a disease in which the bones become soft, weak, misshapen and painful. Severe rickets can cause serious health problems, developmental delays, and other health problems.

Breast milk alone does not provide infants with an adequate amount of vitamin D, so prolonged exclusive breastfeeding without vitamin D supplementation can cause rickets. Formula is fortified with vitamin D, but it doesn’t provide enough unless the baby drinks 32 ounces each day. The American Academy of Pediatrics recommends that all infants who are at least partially breastfed or who consume less than 32 ounces of vitamin D-fortified formula per day receive 400 IU of supplemental vitamin D per day. After the first birthday, the recommended amount increases to 600 IU per day.

Although sunlight can be a source of vitamin D, the AAP strongly recommends that all children stay out of direct sunlight as much as possible. They also recommend using shade and clothing as protection for babies, especially those under 6 months of age, instead of sunscreen whenever possible.

The main reason I take vitamin D is for immune health. What does the research say about this?

Vitamin D plays an important role in immune system function, but it’s still unclear whether taking vitamin D supplements can “boost” immune health. Some research has focused on whether vitamin D can reduce the risk of developing an autoimmune disease, in which the body’s immune system attacks its own organs and tissues, while other research has looked at whether taking vitamin D supplements can help the body fight infectious diseases such as colds, seasonal flu and COVID-19.

The Vitamin D and Omega 3 Trial, which I wrote about last month, found that taking 2,000 IU of vitamin D a day for five years reduced the incidence of autoimmune disease by about 22%, compared with a placebo. For context, 123 participants in the vitamin D group were diagnosed with an autoimmune disease during the study, compared to 155 participants in the placebo group. Autoimmune conditions seen in the study included rheumatoid arthritis, psoriasis, and autoimmune thyroid diseases (Hashimoto’s thyroiditis, Graves’ disease). Other examples are multiple sclerosis, type 1 diabetes, lupus, and inflammatory bowel disease. Keep in mind that someone’s risk of developing an autoimmune disease is partly genetic.

Results of a randomized controlled trial published earlier this month in the British Medical Journal found that participants who did not take vitamin D supplements and then took either 800 or 3,200 IU of vitamin D per day for six months did not have less likely to contract the COVID virus than participants who did not take vitamin D. The authors of this study noted that their findings were consistent with other recent randomized controlled trials that reported no effect of vitamin D supplementation on the risk of upper respiratory infections.

Are gummy multivitamins as good as brands that come in pills or capsules?

Multivitamin and mineral supplements come in a variety of formulations: tablets, capsules, softgels/gelcaps, powders, liquids, chewables, and gummies. For most people, the “right” vitamin formulation is the one you prefer. If the product is manufactured correctly so that it can deliver the nutrients to the digestive system and dissolve once it gets there, the formulation doesn’t matter. Gummy vitamin supplements are an exception.

Gummy vitamin and mineral supplements contain fewer nutrients than their “regular” counterparts, because some vitamins and minerals are not easily incorporated into gummies and others are not included due to the bad taste. Compare a gummy multivitamin to a standard multivitamin and you’ll find that gummies contain fewer nutrients, have smaller amounts of the nutrients they contain, and tend to be more expensive. They also expire sooner, as the wet, gel-like consistency of gummy supplements can cause some of the nutrients to degrade more quickly.

The Center for Science in the Public Interest tested 37 brands of gummy multivitamin/mineral supplements, and none came close to being a good substitute for a regular multivitamin pill. ConsumerLab’s independent testing found that some gummy supplements, especially gummy multivitamins, do not contain the amounts of vitamins or minerals listed on the label or contain impurities.

Are dietary supplements regulated or not?

The dietary supplement industry brings in billions of dollars each year, with approximately 90,000 products on the market, including vitamins, minerals, herbs or other botanicals, amino acids, probiotics or other substances. A 2015 Consumer Reports survey found that most people think dietary supplements are vetted for safety by the US Food and Drug Administration. Unfortunately, this is not true.

Unlike prescription or over-the-counter drugs, which must be approved by the FDA before they can be marketed, the FDA is not authorized to review dietary supplements for safety and effectiveness before they are sold. The FDA can take action through warnings or recalls, often voluntary, if they receive reports that a supplement already on the market is causing harm, but that can take several years, if at all, and may not be effective.

One of the biggest concerns about supplement safety is adulteration with off-label ingredients. Several independent organizations, notably the US Pharmacopoeia, ConsumerLab, and NSF International, provide quality testing. Their seals of approval mean that the supplement was manufactured correctly, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. This can give you confidence that the product is not adulterated, but does not guarantee that a product is safe or effective.

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