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Ep. 31- Vitamin D: How to supplement and Why we need to

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This is Maureen Farrell and Heather ONeal. And this is the Milk Minute an inclusive evidence-based podcast. Hosted by midwives and lactation professionals. That’s us! Here to talk to you about all things, lactation and boobs, body positivity, mental health, all the milky topics. Join us for another episode.

Welcome to the Milk Minute! Today, we are going to talk a little bit about vitamin D. Yeah. Today we’re going to talk about the D. Not the D you’re thinking of you pervert, the vitamin D. The one that comes from the sun. Yes, we are like plants. We take the things that the sun gives us, and then we turn them into magical vitamins that we use to make our bones strong.

So that’s basically what vitamin D well, that’s originally what we thought vitamin D did, but it’s been shown to do many other things and prevent many illnesses. Yeah. It’s great for your immune system. So, side note, just cause, you know, we’re all still concerned about COVID and everything. If you do supplement with vitamin D, we have some preliminary research showing that you might do better if you get COVID so you should probably all be supplementing with it anyway.

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Let’s start with the bad shit that can happen if you. Don’t have enough vitamin D cause that’s fun to know. Yeah. Well, I guess we could even back it up a little bit before that, and we could remind people about our ‘History of Formula Episode’ and what we discovered was that because they were not putting vitamins and minerals in the original form of formula, all these kids were getting rickets, which is where your bones are really soft and they in your legs bow. It’s really awful. And basically, you’re left with a bunch of deformed children. And so clearly that upset people and they were like, we should start paying attention to how important vitamins are in our life.

So, I think that’s the basis of where the interest in vitamin supplementation began. Yeah, and I guess to bring us to the present here, humans, theoretically, should be able to get enough vitamin D from the sun and from the foods they eat, because a lot of fruits and vegetables grown in the sun have vitamin D in them.

But most of us, especially in the Northern hemisphere or people who work inside or just basically don’t spend their whole day outside, we’re vitamin D deficient. And also, people with darker skin. Yeah. You know, I honestly spend several hours a day outside almost every day and I’m still vitamin D deficient.

I’ve had Amish and Mennonite clients who spend their entire days outside, still be vitamin D deficient. So, this is very common. And if you’re one of those people, who’s like, oh, but not me. Maybe just get tested and see. Yeah. I mean, okay, so this is where you start to lose me because I am such a fan of the human body and nature. And nature so far has really figured out most things.

You know what I’m saying? Like, we tend to try to over fix things that aren’t really broken in the medical community much of the time, but also, is it a big deal? You know, like, is it natural for us to maybe not have that much vitamin D? Is it natural for us to not be able to process it… the way we feel like we should process it? Like shouldn’t nature have fixed that by now?

But then the other side of me gets it, you know? Cause we’re not outside a lot. Most of us are inside with fluorescent [00:05:00] lighting and not eating the best foods. So, I don’t know. What are your thoughts on that, Maureen?

I mean, I’m there with you. I totally feel that. And a couple of times in the past few years I’ve been like, I’m going to really dig into this and figure it out. And the reality is we don’t have that answer. And you know, I did read some interesting research that mentioned how our bathing habits and our skincare habits might have something to do with it as well, because it’s not like we’re out in the sun, bam, we have vitamin D. So, we have this like precursor to vitamin D that we get from the sun and then our body uses that to synthesize it. But if we wash our skin too soon, we don’t have that precursor. What? Yeah. So, the people who shower like three times a day, or like they go for a run and immediately hop right in the shower, you might not be making vitamin D from that sun exposure.

That’s interesting. Yeah. And that at least like clicked one thing in my brain for me, where I was like, oh, it’s actually only very recently in human history that we’ve been bathing this much. Maybe that is it. Like maybe nature has figured it out, but we just keep jacking it up. That makes sense.

Yeah. I mean, that’s my assumption with this whole issue is that probably if we actually consistently ate food that had enough vitamin D in it, because it was grown properly and we consistently spent enough time in the sun and we didn’t like cover our skin in weird products and shower six times a day we’d probably be fine, but the reality is most people don’t do that. And like, I don’t know that we actually have data and testing from communities that do live more like that. So, I don’t know.

Well, and also it’s important to mention that there are a few dietary sources of vitamin D, but they’re not significant enough to provide the actual amount of vitamin D that we really need to function and prevent disease processes and, you know, prevent osteoporosis and all that.

So those foods are Cod liver oil. Delicious. Fish such as mackerel, tuna and salmon, egg yolk, beef liver, and four to five dairy products. So, most of us aren’t running around eating and drinking Cod liver oil and all of these large ocean fish. So, the government, our government at least has put a lot of these vitamins into random stuff like cereal, like, oh, Americans eat a lot of, really piece of shit cereal… let’s just put folic acid and vitamin D in that. And then, you know, we’ll solve all their problems for them.

Yeah. And really, I imagined when most humans had a much more significant portion of their diet be vegetables and fruit that grew outside… we also got a significant amount of vitamin D from that, but really, at least in this country, you know what I think of as the SAD diet, the standard American diet is abysmal like kids whose daily serving a vegetable is ketchup… I’m sorry, that does not have vitamin D in it, but like tomatoes that you grew in the sun and sun dried, they have vitamin D. A lot of mushrooms have vitamin D especially when you dry them in the sun, which is interesting.

But again, it’s just like, nobody eats enough of that anymore. Yeah, that’s true. And you know, I guess another thing to say about trusting our bodies, our bodies are set up to make very large amounts of vitamin D through sun exposure. So, in 24 hours, your body can fabricate 10,000 to 20,000 international units of vitamin D.

And that’s only with like, 15 to 20 minutes of summer sun exposure in a bathing suit, or if you’re a darker skinned 45 to 60 minutes in the sun and then your body makes all that wonderful vitamin D. But because we use sunscreen now, because we are obsessed with skin cancer and not getting it. Which is reasonable, but also, yeah, maybe, maybe not. I don’t know.

If you really look at the research on that also sunscreen since we’ve started using it has not decreased the amount of melanoma that we are dying from. Well, there you go, folks. So yeah, maybe just getting in the sun. Now I don’t feel so bad about the fact that I never wear sunscreen.

I really don’t either. I think that the majority of people are concerned mostly about wrinkles these days. Like I don’t want to get wrinkles. I didn’t even think of that. There’s sunscreen in all of our makeup products. Did you know [00:10:00] that? I don’t wear makeup, but I did know that. That’s why I said it condescendingly, like, did you know that you non-makeup wearer?

I don’t know. The only time I wear sunscreen is when I’m like, I know I’m going to have direct all day long sun exposure and I am going to get burned and it’s going to suck. Right. That’s like the only time I put it on my kid too. And I’m like we’re literally going to be under the sun nonstop.

Right, and if you can’t get away from it then, yes. So basically, our bodies are very efficient at making it, but are we able to absorb it through food? Are we able to actually get it into the breast milk is a different story. So that’s where things start to get a little bit sticky. It’s like, yeah. If it was just us, we’d say go lay in the sun every day. With just a bathing suit on and absorb it. That’s great. But then the problem is getting it from that, into the breast milk and then into your baby.

Yeah, and I really used to be that provider that was like, just spend more time in the sun and spend time in the sun with your baby. But the reality is that I realized people don’t do that even when I recommend, they do.

And, you know, we just… we’re missing some part of the research here as to why that doesn’t seem to work for everybody. Yeah. If there’s one thing that I can definitely say about doing this research, there’s a lot of holes. There’s a lot of repetitive information and then there’s a lot of holes as to like, okay, why?

Like go deeper… we need that next level of research now. Yeah. I want to know like, is there some heavy metal that we all have, you know, a high amount of that’s jacking up this process. Is it some toxin we’re all exposed to? Is it like we’re eating too much of some kind of processed food? Like, I don’t know, but there’s got to be something that’s messing with this process, but that’s probably also a huge pain in the ass to set up a randomized trial about.

Right. And then, so there’s that piece, but then there’s also the, why is it important? Because so far, the only thing that they have for sure found is that if you do not have enough vitamin D in your diet, you. And your baby can get, or your baby mostly can get rickets, but then you can have of osteo-malesia.

Yep. So, and yeah, they did find like this was the only hard number that I found was that approximately 10% to 20% of extremely low birth weight, infants have radiological evidence of rickets with metaphyseal changes. Despite current nutritional practices. So, it’s worse for premature babies. They’re not able to absorb as much vitamin D as full-term babies.

So that was really the only hard evidence I found something else that said anecdotally, which means, you know, just what people say, and then as a correlation study, which is not the strongest evidence, it’s like, oh, we have evidence to do another study. Right. So, here’s the evidence that we have to do all these other studies.

There have been correlations found between vitamin D deficiency and cancers, specifically of the colon, breast and prostate, hypertension, diabetes – both type one and type two, and multiple sclerosis, rheumatoid arthritis and other auto immune conditions. So those are like all over the map. It’s like, basically it’s correlated with your body’s falling apart, but why?

So? Like, we need more, that’s the next piece that I want. And here’s my anecdotal piece in the practices I’ve been a part of that test for vitamin D deficiency prenatally, when people are still vitamin D deficient close to labor, we see more dysfunctional labors. And that’s not a big study, but again, anecdotally, I’ve heard that from other providers who actually bothered to test for vitamin D levels.

And I think it’s been significant enough and you know, the data that we see otherwise about, you know, the potential harms and also the lack of potential harm from supplementation, you know, just makes me really recommend to people that they supplement, at least during their pregnancy and while they’re breastfeeding.

You know, it seems like this is probably the best thing that we can suggest. Well, you know, that’s interesting that you say that because the US National Institute of Health reports that 81% of women of childbearing age have insufficient levels of vitamin D. And so that’s the US, right? And in the US, we have some of the most dysfunctional labor, we have some of the worst statistics.

So, I’m not saying that vitamin D supplementation in pregnancy is going to fix all of that, but it sure is a good, easy [00:15:00] place to start. I mean, what could happen? You know, it’s pretty rare that you can intoxicate yourself on vitamin D. Right. And I think that honestly, it would be so easy to set up a study that at least collects data for this… where we just say, okay, we’re going to add one prenatal test to the panel because most people, if they birth at a hospital, they have their blood drawn at least twice. Right? So we’re going to say first trimester blood screening, we’re going to add vitamin D levels, third trimester, we’re going to add vitamin D levels and just then create this data set of vitamin D levels and, you know, outcomes of labor and see what comes up with from that.

Yeah, that would be really awesome. And then also some research did come out a couple of years ago. I think it was from Pittsburgh… somewhere in Pittsburgh that linked very strongly, vitamin D deficiency and chronic vaginitis.

So, which makes sense because, you know, vitamin D is a huge player in your immune system. And when your immune system is messed up your vagina, which is like this amazing place of natural flora and your microbiome at its best is affected. And then you start getting like, I’m just chronically itchy, or I just have this weird smell or, you know, sex is weirdly painful all of a sudden and I don’t know why. So, you know, then we draw vitamin D levels and low and behold it’s less than 20 and we’re like, ooh.

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I guess we should probably tell people what the normal levels are. So yeah, deficient is definitely less than 20. We like to see it above 32, somewhere in between there we’re recommending supplementation. Right, Maureen? Yeah, usually I recommend supplementation if I see something below 25, I say to definitely supplement.

If someone’s closer to that 30 mark. You know, I’m like, well, there’s no harm in supplementing, you know, but you can take this low dose. We’ll retest, if you want to, it kind of depends on the client. Some people are more than happy to throw an extra gummy vitamin at themselves. And some people just really hate taking supplements. So, you know, I don’t really push it unless they’re super low.

Right. If they’re low and you can see it, like they’re fatigued, and they have chronic vaginitis and they’re sick all the time. And you know, then it’s like, okay, this is affecting your life. So, I’m sorry that you hate vitamins, but like, do you also hate being tired and sick all the time?

Right. And the reality is a lot of people take a multivitamin. They’re like, well, there’s vitamin D in there, but it’s only like, 200 IUs or 400 IUs and it’s recommended most adults take closer to 2000 IUs per day. And so, me with my level of 22, I’m taking 5,000 a day now. Yeah, I think I did 5,000 during pregnancy every day.

And we recommend that you start supplementing yourself in pregnancy because your baby will be born ahead of the game, like at normal, because your baby can be born deficient in vitamin D if you are deficient in your pregnancy. Yeah. And like, you know, you’re already so sick and tired in pregnancy.

So, I think you need to give yourself the best chance you can at, you know, not feeling miserable through that experience and vitamin D really people do report that they feel better when they have enough vitamin D. Yeah, they do. I mean, I can say that I have stopped my vitamin D supplementation. Why? I don’t know.

I don’t know why it just. I just stopped. I do that too. I’m like, that vitamin, that, you know, the bottle fell behind the counter and now I’m not going to buy a new one for the next year. I definitely felt better when I was on it and I went off of it and got coronavirus. So, you know, there you go. Lesson learned; lesson learned.

[00:20:00] So we need to talk about the American Academy of Pediatrics, actual recommendation for your infant. So, you know, we’ve kind of covered, we’ve discussed it. We’ve covered what the recommendation is for us as adults, to take at least somewhere between 2000-6400 international units a day.

But the American Academy of Pediatrics recommends supplementing your baby with 400 international units per day of vitamin D beginning in the first few days of life. And then continuing through childhood. And that’s, even if you’re supplementing with a little bit of formula, they are still recommending this.

And honestly, I didn’t know that. I thought that if you were having any formula, then you were getting plenty of vitamin D. I am wrong. So, I feel like if I didn’t know that you all probably didn’t know that. So, you know, it seems like you’re interrupting a natural process, but really, you’re not, you’re kind of just enhancing the natural process that’s already there as a just-in-case measure and also to set your baby up on the right track. So, they don’t become an adult who’s chronically deficient.

Yeah. And it’s actually recommended to consider an even higher dose if you live in the farther Northern reaches of our world, or if your baby is very low birth weight, or dark skinned. Yes, or dark skinned as well. And when we are talking about very low birth weight, we’re talking very low. So that’s less than like 1500 grams, which is what, how many pounds. Three, four, something like that. Yeah. It’s small. So, this isn’t, you know, that’s not like, oh, my baby was six pounds… it’s small. That’s a normal size. Just FYI. Not every baby has to be 10 pounds, but yeah, those really small babies, they’re typically very premature. And usually, you know, the hospital’s going to take care of that, but if you’re taking your baby home from the NICU, you want to make sure that, you know, how much of that supplement you need to be giving.

And can I just give a little tip here? Because I was a nurse in the NICU for a while and we had to give the vitamin drops to the babies and the vitamins that we gave the babies there were all the vitamins, you know, it wasn’t just vitamin D it was like these babies need all the vitamins and the iron, and it’s disgusting. It’s liquid, and it is just the worst smell. I mean, it was horrible. So, my first time giving this vitamin, I just tried to shoot it right into the baby’s mouth, which it drank. And I was like, perfect. And then five minutes later, the projectile vomit that came up. With this vitamin was just… it was yellow. It stunk. And the baby looked at me like, “you stupid idiot that was the worst thing ever.” And I felt so bad. So then one of the kinder, older, more experienced NICU nurses pulled me aside and she was like, honey, let me show you how to do this. So, the vitamin D drops probably aren’t going to be as nasty tasting as what I gave, but if you have a baby that is a little bit picky, this is what you can do. You can either hand express a little bit of your milk, or if you already have some expressed milk, you can just take like five CCs, not even that much and mix it with the vitamin drops and cup feed it to them and then follow with a breastfeed.

Or bottle feed, whatever you do. But that way I don’t recommend putting the drops in a big bottle, because if they don’t like the taste, then they then you’ve wasted that whole bottle. So, you only mix it with like five CCs, just a little tiny tablespoon, and then you can wash it down with a nice, delicious booby or a nice delicious bottle untainted by the vitamin drops.

And so, you know, some people will try to like sneak in with the syringe while the baby’s on the breast. I don’t like that because it will drip out a baby’s mouth. You won’t know how much baby is getting, and you can create an aversion at the breast. You don’t want them to think that every time they get to the breast, it’s going to be like that because then they’ll start trying to reject it.

So, you don’t want to create any behavior issues there. So definitely just cup feed it or spoon feed it with just a little bit of your milk mixed in. Or, the other thing that you can do is take it yourself. So, this is another good option. If you don’t want to just give your baby the drops, you can take a higher dose of vitamin D.

However, we want you to get a baseline, first of where your vitamin D is. So, you know how much to supplement. Yeah, and any doctor can do this. It’s the test is usually covered by insurance, but it’s not cheap if you have to pay out of pocket. So, [00:25:00] definitely make sure that it’s covered before you get that.

And I don’t believe the American Academy of Pediatrics technically recommends it, but we have a lot of good data that shows that maternal supplementation does provide babies with enough vitamin D through breast milk. Yes, but you have to have at least 6,400 international units. Right.

So, you do need to be supplementing a lot. These days you can find gummies that are like 5,000 IUs each, so it’s not hard to do, but it’s just something that you should probably make sure you that you’re good at taking your vitamins every day. And you know, you kind of have that under control. Here’s my question though… and when I was reading over a lot of these studies about, there’s a lot of studies that indicate that infants who are exclusively breastfed are at a high risk for vitamin D deficiency. However, Heather, did you see that if any of those actually reported real impact on those infants from that deficiency, the way that it did with like the very low birth weight infants? No, I just kept seeing rickets come up over and over and over again, which yes, we get it, we know that, but it has to be very severe. Well, I take that back, I did come across a study that said that if your child is born deficient with vitamin D and continues to be deficient through childhood, you will see an increase in respiratory illness in that child compared to other children who do not have deficient vitamin D. So, I mean, that’s an immune system thing.

Yeah. I mean, that’s significant for a lot of people, especially when, honestly, it’s like, especially when your babies are born during RSV season and during the global pandemic where we’re dealing with a respiratory illness like that’s a real thing to consider for sure.

Yeah. I mean, having had Corona virus, if I had known a month ago to start taking my vitamin D again, you better believe I would have done it. Cause it was no picnic. It’s still not a picnic. I’m in my cheetah bathroom right now, mustering all the strength that I can to get fired up about vitamin D right now. Like, what the heck?

You know, I’m going to be real here, guys, when I’m talking about those clients, who don’t like to take supplements and I’m actually just talking about myself here… also people I work with, but like I fit into that demographic. I really, until like the last two years was so anti-supplements, I was like, I can get everything from the food I need eat and blah, blah, blah. But also, then I did a lot of research into how deficient our soils are in vitamins and even like the soil on my farm, you know, has vitamin deficiencies, the soil on the farm that I get most of my food from, you know? I’m one of those people who gets almost all of my vegetables from a local farm, and yet still I have to supplement because all of our soils here are deficient and the things that we need from really poor growing practices for the last hundred years. It sucks, and I finally came to terms with that. I take my vitamins. Yeah. I definitely need to start again. So, I will make a pledge that I will start supplementing with vitamin D again.

Now this is the second pledge that I’ve made on the podcast. The first one I did complete, I watched Hamilton and I have to say it was very good. The first 10 minutes I was confused, and my brain was working really hard because I did not really know what to expect. And honestly, it’s been so long since I’ve studied the revolutionary war era that I just was like, my brain was just digging stuff back up from second grade. I was like, what? Yeah, you’re like social studies come back to me! Yeah, I know it’s in there somewhere, but then I was fully committed by like 20 minutes in. I was like, I don’t know what this is, but thank God someone did this. This is great. Thank you. Lin-Manuel Miranda for doing this for us. Nobody asked for it, but we needed it. Exactly. So, if you haven’t seen Hamilton, I highly recommend it, make it through the first 10 minutes and get through the brain cramp and then you will be very satisfied, very satisfied.

So, should we summarize really quickly? Cause I kind of feel like we’ve thrown a lot of numbers out there. So, let me just do a quick little summary. We are pro-supplementation for vitamin D either in baby or through maternal side. So, if it’s, if you’re going to take it yourself as the lactating parent, we recommend taking about 6,400 international units a day.

Babies [00:30:00] on average should take 400 international units a day, if you’re supplementing the baby directly, unless you live in a place where there is much less sunlight or your child is darker skinned, and then you might have to bump it up to… what was it, Maureen? So that actually wasn’t super clear. It said 600 and some places, some places that said other numbers, but 800 to a thousand in Europe, the European Society for Pediatric Gastroenterology recommends vitamin D of 800 to a thousand international units a day for preterm infants. Okay. So somewhere between 400 and a thousand. Yep. Fine. Whatever.

Sorry. So, there’s that super clear summary for you guys? Yeah. Super clear. So, go be like me and go order your vitamin D and start taking it. And do let us know if your vagina’s better or you just have more energy or if you just feel better. Yeah. I’m going to go take my vitamins after this. Cause I haven’t done it yet today.

Yeah. Well, thank you so much for listening to our rant about vitamin D. I hope you all learned something, and I hope it was clearer than mud. Bye guys. Bye.

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