Your doctor has been listening to the baby food industry. There is a reason there are so few foods that contain vitamin D -its not a vitamin its a hormone. Your body is supposed to make it on exposure to the sun. In Canada, in winter, all your baby needs is 17 minutes a day of head and face exposure to make enough vitamin D.
Iron is highly toxic, even in amounts too low to cause acute iron poisoning it can cause health problems. However the amount of iron in breastmilk will not increase past a certain point -your body is protecting your baby. However if you continually take more than upper tolerable amount of iron your health will suffer, your immune system will not work as well as it could, you will not have enough copper in your system, etc. Almost all prenatal vitamins contain more than the upper tolerable amount of iron, and your diet contains a significant amount as well. Nearly all grain products and processed foods are fortified with iron, and almost all veg, fruit, and all meats are rich in iron. So unless you are living on sand you are getting iron from your diet.
Supplementing the non-anemic baby also has negative impacts on their health. Adding ANYTHING to the baby's diet except breastmilk changes the flora and pH of the gut and can remove some of the protective benefits of milk. But add in iron that is accessible to bacteria (unlike the iron in breastmilk) and vitamin D in a peanut oil base and you are begging for problems.
http://www.kellymom.com/nutrition/vitamins/iron.html
Why not use iron supplements as a protective measure for every baby?
The iron in breastmilk is bound to proteins which make it available to the baby only, thus preventing potentially harmful bacteria (like E.coli, Salmonella, Clostridium, Bacteroides, Escherichia, Staphylococcus) from using it. These two specialized proteins in breastmilk (lactoferrin and transferrin) pick up and bind iron from baby's intestinal tract. By binding this iron, they
1. stop harmful bacteria from multiplying by depriving them of the iron they need to live and grow, and
2. ensure that baby (not the bacteria) gets the available iron.
The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby's iron absorption. As long as your baby is exclusively breastfed (and receiving no iron supplements or iron-fortified foods), the specialized proteins in breastmilk ensure that baby gets the available iron (instead of "bad" bacteria and such). Iron supplements and iron in other foods is available on a first come, first served basis, and there is a regular "free-for-all" in the baby's gut over it. The "bad" bacteria thrive on the free iron in the gut. In addition, iron supplements can overwhelm the iron-binding abilities of the proteins in breastmilk, thus making some of the iron from breastmilk (which was previously available to baby only) available to bacteria, also. The result: baby tends to get a lower percentage of the available iron.
Supplemental iron (particularly when administered in solution or as a separate supplement rather than incorporated into a meal) can interfere with zinc absorption. In addition, iron supplements and iron-fortified foods can sometimes cause digestive upsets in babies.
A recent study (Dewey 2002) found that routine iron supplementation of breastfed babies with normal hemoglobin levels may present risks to the infant, including slower growth (length and head circumference) and increased risk of diarrhea.
A recent review article on iron (Griffin and Abrams, 2001) indicates that if your baby is basically healthy, iron deficiency in the absence of anemia should not have developmental consequences.
http://www.kellymom.com/nutrition/vitamins/mom-vitamins.html
According to Nutrition During Lactation (Hamosh, 1991):
"The evidence does not warrant routine vitamin-mineral supplementation of lactating women... Encourage lactating women to follow dietary guidelines that promote a generous intake of nutrients from fruits and vegetables, whole-grain breads and cereals, calcium-rich dairy products, and protein-rich foods such as meats, fish and legumes. Such a diet would ordinarily supply a sufficient quantity of essential nutrients... Encourage sufficient intake of fluids -- especially water, juice, and milk -- to alleviate natural thirst. It is not necessary to encourage fluid intake above this level... Calcium, multivitamin-mineral supplements, or both may be advised when dietary sources are marginal and it is unlikely that appropriate dietary practices will or can be followed."
http://www.kellymom.com/nutrition/vitamins/mom-vitamins.html
Breastmilk levels of calcium, magnesium, phosphorus, zinc, iron and folic acid are fine even if your diet is deficient. If supplements are needed, they are for your benefit -- not baby's.
[...]
Most mineral supplements (e.g., iron, calcium, copper, chromium, zinc) taken by the mother do not affect breastmilk levels.
http://www.kellymom.com/nutrition/vitamins/reference-intake-table.html
Nutrient Iron
Recommended Intake (RI)
(not pregnant or nursing) 18 mg
Pregnancy
(ADD this to the RI) 9 mg
Breastfeeding
(ADD this to the RI) - 9 mg(less needed)
Tolerable Upper Intake Level (UL) 45 mg
http://www.kellymom.com/nutrition/vitamins/reference-intake-table.html#Iron
Per Hale (Medications and Mothers' Milk), no pediatric concerns have been reported via breastmilk when mom is taking iron. Rarely, iron supplements taken by mom may produce constipation in baby.
Iron supplements taken by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Anemia in the nursing mother has been associated with poor milk supply, however.
Nursing moms need 9-18 mg daily of iron (this includes all food sources) - the higher level would be for a mom who has resumed menstruating. If you are anemic, ask your DR what dosage of iron supplement (if any) is recommended. You can often bring your iron levels up just by changing your diet a bit - getting more food sources of iron and vitamin C (which increases iron absorption) - more on this in the link below.
The standard iron supplements are mineral-based (ferrous sulfate). There are also a chelated iron supplement (iron bisglycinate) and a liquid plant-based iron supplement (one brand is called Floradix) that are reported to be easier absorbed and non-constipating. Tinctures containing herbs such as yellow dock and dandelion (here's an example) are also high in iron.
http://www.kellymom.com/nutrition/vitamins/vitamin-d.html
Is your baby at risk for vitamin D deficiency?
First of all, babies rarely need vitamin D supplements. The babies who do need these supplements need them due to a lack of sufficient sunlight. Factors that put your breastfed baby at risk for vitamin D deficiency (rickets) are:
* Baby has very little exposure to sunlight. For example: if you live in a far northern latitude, if you live in an urban area where tall buildings and pollution block sunlight, if baby is always completely covered and kept out of the sun, if baby is always inside during the day, or if you always apply high-SPF sunscreen.
* Both mother and baby have darker skin and thus require more sun exposure to generate an adequate amount of vitamin D. Again, this is a "not enough sunlight" issue - the darker your skin pigmentation, the greater the amount of sun exposure needed. There is not much information available on how much more sunlight is needed if you have medium or darker toned skin. See the section below regarding amount of sunlight needed.
* Mother is deficient in vitamin D - this is rare in western countries. The amount of vitamin D in breastmilk depends upon mom's vitamin D status. If baby gets enough sunlight, mom's deficiency is unlikely to be a problem for baby. However, if baby is not producing enough vitamin D from sunlight exposure, then breastmilk will need to meet a larger percentage of baby's vitamin D needs. If mom has minimal exposure to sunlight (see above examples) and is not consuming enough foods or supplements containing vitamin D, then she may be vitamin D deficient. More below on supplementing mom with vitamin D.
Vitamin D supplementation is often recommended particularly in Canada and other northern latitudes, since these areas don't receive much sunlight during certain parts of the year. If you live in the far north and don't receive much sunlight, you might consider a vitamin D supplement. However, Dr. Jack Newman, a Canadian pediatrician and breastfeeding expert, indicates that Vitamin D supplements are rarely needed - even in Canada. The 2002 results of the Canadian Paediatric Surveillance Program confirmed 20 cases of nutritional rickets in Canada during 6 months of study. The researchers noted that:
"Intermediate- and dark-skinned children who were breast-fed without vitamin D supplementation were at risk for the disease. Among identified cases, the mothers were frequently veiled, did not receive vitamin D supplementation following delivery, and infrequently ingested milk (thus eliminating a potential dietary source of vitamin D)... A subset of residents in Canada are particularly at risk for nutritional rickets, including darker-skinned, breast-fed infants whose mothers adhere to a diet that is low in vitamin D and have limited sun exposure." [p. 43-44]
Per [Hamosh 1991, p. 156],
"In summary, exclusive breastfeeding results in normal infant bone mineral content when maternal vitamin D status is adequate and the infant is regularly exposed to sunlight. If the infant or mother is not exposed regularly to sunlight, or if the mother's intake of vitamin D is low, supplements for the infant may be indicated."
World Health Organization information [Butte 2002, p. 29 PDF] states,
"...although there is abundant evidence suggesting that breastfed infants often receive less vitamin D than is required, most studies fail to find rickets in breastfed infants less than 6 months of age... infants who are exclusively or predominantly breastfed for 6 months or longer can be at an increased risk of rickets if their mothers are at risk of vitamin D deficiency, and the infants receive limited sun exposure and no vitamin D supplements."
If you are in doubt as to whether vitamin D supplements are needed and prefer not to give supplements "just in case" -- getting a blood test to determine the vitamin D status of you or your child is always an option.
Recommended vitamin D intake
In the US, the recommended intake of vitamin D for babies and lactating mothers is 200 IU (5 micrograms) per day, the same as for anyone else under the age of 50.
Infants 0-12 months should not exceed 1,000 IU (25 µg) per day. Anyone aged 1-50 years should not exceed 2,000 IU (50 µg) per day.
The amount of vitamin D in human milk is small: 0.5-3.4 µg/liter (20-136 IU/liter) [Hamosh 1991, Good Mojab 2002] in mothers who are not vitamin D deficient. However, the vitamin D in human milk is in a form that is very easily used by the baby and therefore adequate for most infants, when combined with a small amount of sun exposure.
http://www.kellymom.com/nutrition/vitamins/vitamin-d.html
nlight exposure needed to achieve adequate vitamin D status*
Infant Group Clothing Minutes/Week Average Minutes/Day Reference
Caucasian infants,
0-6 months old,
latitude 39°9'N,
Cincinnati, Ohio, USA fully clothed without a hat 120 min/wk
(2 hours) 17.1 min/day Specker 1985
diaper only 30 min/wk
(1/2 hour) 4.3 min/day
Chinese infants,
1-8 months old,
latitude 39°55'N,
Beijing, China fully clothed without a hat 168 min/wk
(2 hrs, 48 min) 24 min/day Ho 1985
(avoid exceeding this amount)