Dear Mamas,
My 14-month-old weighs 23 lbs. and is a healthy, happy toddler. My question is about how much vitamin D she should be getting, both in her diet and with supplements.
I’ve read about the benefits of higher amounts of D during cold and flu season to help support immunity, and also that most children don’t get enough from their regular diets. Then recently I’ve heard that TOO much can be dangerous.
Her pediatrician said I can give her 800 IUs (I give her a drop from a bottle that dispenses 400IUs at a time). But then the whole milk she drinks is fortified with Vitamin D. I’m so confused! What’s the right amount? I don’t want to cause her harm.
Wondering How Much is Too Much
Dear Wondering,
You’re in good company. The recent research is somewhat contradictory, and pediatricians and parents are both confused.
Whenever a medical or nutritional topic comes under debate I like to take a step back and look at the big picture. The fact that the ‘experts’ were so recently concerned that kiddos weren’t getting enough vitamin D, and now they’re just as concerned that they may be getting too much should give us pause. Until the dust settles a middle road is the safest bet.
The American Academy of Pediatrics recommends that children who drink less than one liter (about a quart) of milk a day take 400 IU of supplemental vitamin D each day. Good sources include:
• Sunlight. The body makes Vitamin D when skin is exposed to UV rays. A small amount of outside time (5-15 minutes) can provide about 100 IU.
• Multivitamins. Most children’s chewables or drops contain the recommended 400 IU.
• Foods such as vitamin D fortified milk, orange juice, dairy products and cereals,fatty fish including salmon, tuna and sardines, and eggs are all excellent sources of vitamin D.
Taking too much vitamin D can cause a number of side effects, however scientists don’t all agree on how much is too much. The National Institutes of Health has set the maximum upper limit at 1,000 IU daily for children up to age 12. You can’t get too much vitamin D from sunlight and food sources, but over-supplementation can result in excess. Until all the experts are on the same page, the recommended supplemented dose is adequate but won’t overdo it. Sometimes it’s hard to keep up with all the conflicting advice out there, but good for you for trying!
~ the Mamas
The information provided by MamasOnCall is not intended as a substitute for professional advice, but is for information purposes only. You assume full responsibility for the health and well-being of your family. Talk with your healthcare provider about any questions you may have regarding a medical or psychiatric condition.
Can you give us examples of the problems you have had to treat that you felt were caused by vitamin D supplementation? I’ve read that back in the ’60′s infants in Finland were regularly given the equivalant of 4,000 IU per day.
Hi Auburn, I get your point. Vitamin D overdose typically happens over a period of time rather than from a single large dose. This is because, unlike most other essential nutrients we consume, the body does not excrete excess vitamin D. Instead, it is stored in the body’s fat cells where it can accumulate to toxic levels over time. Some of the health risks of excessive intake of vitamin D are elevated levels of calcium in the blood, resulting in abnormal deposition of amounts of phosphate and calcium in soft tissue such as the lungs, heart and kidneys, nausea and vomiting, poor appetite and loss of weight, high blood pressure, heart rhythm irregularities and increased risk of heart disease, kidney stones and renal failure. Overdose of Vitamin D in pregnant women can cause mental or physical retardation in babies. Are these common or likely? No. But once the effects occur over years of elevated vitamin D intake they’re quite difficult to reverse. More is not always better, and vitamin D may be an example of that.
There are very few cases in the litereature of Vitamin D overdose. Where one does find cases, the doses have been in the 100′s of thousands iu per day for many months. Any dose of 10,000iu per day is perfectly safe (R. Vieth-Toronto). Signs of toxcity do not occur until 50,000 iu per day is ingested over an extended period. In any case, the defining measurement is a D blood test. If nature is any guide, then optimum levels are 60-80- ng/ml, the level lifeguards at the end of the summer or sun-exposed people who live in the tropics would have. You state that “more is not always better”, but because vitamin D deficiency is rampant, more is better that less! The following vitamin D researchers do agree that people need more not less vitamin D:
Reinhold Vieth, Heaney, Michael Hollick etc.
Dr. Zahan, Thank you for responding to my previous comment. I’ve been following the vitamin D research saga (via Internet searches) on a daily basis for more than eight years. You noted “the health risks of excessive intake of vitamin D are elevated levels of calcium in the blood, resulting in abnormal deposition of amounts of phosphate and calcium in soft tissue such as the lungs, heart and kidneys, nausea and vomiting, poor appetite and loss of weight, high blood pressure, heart rhythm irregularities and increased risk of heart disease, kidney stones and renal failure. Overdose of Vitamin D in pregnant women can cause mental or physical retardation in babies.” Such admonitions are quite common and undoubtedly would cause one to be quite cautious. I have observed, for instance, that persons taking Fozamax are quite comfortable with the drug notwithstanding the extremely serious side effects disclosed in the package insert or in advertising, but hesitant to take the amount of D-3 that would be necessary to raise their blood level of 25(OH)D to an effective or optimum level for bone health.
Other than the several people who inadvertently were taking a dose of probably several hundred thousand IU per day I have not been able to locate actual case studies of overdose adverse consequences. I’ve often wondered if the warnings are based on theoretical results. Apparently people who are borderline deficient in magnesium may experience headaches (and perhaps other conditions associated with magnesium deficiency) after being on a vitamin D supplement for a period. I understand this is usually corrected by taking a magnesium supplement.
One on the more intriguing studies on the benefits of adequate vitamin D is The Relationship of Vitamin D Deficiency to Health Care Costs in Veterans, Peiris, et al, published in Military Medicine, Vol. 173, December 2008. Deficiency in this study was pegged at <20 ng/mL. Overall medical expenditures were 39% higher in the vitamin-D deficient group over a 24-month period. If controlling health care costs is of national concern this might suggest that an effort to attain an optimum vitamin-D level might be a good way to start. I doubt that such an effort would sit well with health care providers or the pharmaceutical industry. Imagine cutting the need for health care in the magnitude suggested by this study—or even a fraction of that amount.
I would suggest that there must be a better understanding regarding the association of an adequate intake of vitamin-D with improved health and then striking a proper balance with any highly unlikely or even unproven adverse reactions. In my opinion the unlikely occurrence of an adverse result from taking a daily dose of 5,000-6,000 IU/day or even 10,000 per of D-3 pales in insignificance compared to the potential benefits shown in numerous studies conducted by responsible scientists.