An analysis of vitamin K supplementation
Are all babies really born deficient of a vital health component, as modern medicine insists?
Before we begin: a disclaimer. The decision whether to give vitamin K to a newborn child should not be based solely on the information contained in this article. Parents should make this decision together with a trusted healthcare professional who provides information necesssary for informed consent — of the risks and benefits of both giving and not giving vitamin K (orally or intramuscularly).
CDC: All humans are born deficient
Let’s start with the CDC, a very good place to start (but not finish). According to the CDC:
All babies are born with very low levels of vitamin K in their body, which they refer to as vitamin K deficiency.
Sufficient vitamin K is needed to produce the substances that enable blood to clot.
Hard-to-control bleeding (including potentially fatal internal bleeding) can occur in young babies in the first six months of life, because of their low levels of vitamin K.
Vitamin K Deficiency Bleeding or VKDB (as they refer to it) is only rare because most babies get a vitamin K shot shortly after birth.
The dose of vitamin K given to newborns is not too high for the infants to properly metabolize.
Injecting vitamin K into the baby’s thigh muscle ensures a “steady source” of the vitamin for two to three months or more.
There is no evidence linking vitamin K supplementation and childhood cancer.
Regarding the statistics on what was once referred to as “hemorrhagic disease of the newborn,” that is, bleeding in the newborn period (and up to six months of age), the CDC has this to say:
The rate at which VKDB occurs in the first 7 days of life ranges from 1 in 60 to 1 in 250 newborns who do not receive vitamin K.
VKDB between age 8 days and 6 months is rarer, occurring in 1 in 14,000 to 1 in 25,000 babies.
Babies who do not receive any vitamin K at birth are 81 times more likely to develop VKDB than babies who receive the intramuscular injection.
Babies who receive oral vitamin K drops are 13 times more likely to develop VKDB than babies who receive the intramuscular injection.
Based on these assertions, the CDC insists that all newborns should receive intramuscular vitamin K injections within hours of birth. Indeed, parents who decline this injection (especially if they simultaneously decline the Hepatitis B vaccine and antibiotic eyedrops usually given right after birth) risk being reported to child protection services.
If vitamin K stops the bleeding, then lack of vitamin K caused it (?)
Hemorrhagic disease of the newborn (HDN) was first described as a distinct condition in the medical literature in the late 19th century, although unexplained bleeding in very young babies had been described in detail much earlier. It was believed that infants bled because they were not feeding from their mothers enough, or often enough; or that the mother must be malnourished. However, in the first half of the 20th century, scientists isolated and identified vitamin K, which was associated with the ability of the blood to clot (hence the “K” for “koagulation” in German).
Babies are indeed born with comparatively low levels of vitamin K in their bodies — this much is not in dispute. Human clotting factors need the presence of some vitamin K to be activated. Precisely how much is not known. That most babies do not spontaneously start bleeding internally and do not bleed uncontrollably after a puncture wound, is also not in dispute. Nor does anyone question the use of vitamin K to help stop bleeding. Nonetheless, in 1999 the official name for the condition was altered from hemorrhagic disease of the newborn to “Vitamin K Deficiency Bleeding” (VKDB), as if the cause of the bleeding were the relative lack of vitamin K. This has never been proven and it may never be.
It makes little sense to on the one hand state that all babies are born deficient of a vital ingredient for blood clotting and on the other hand to admit that for the vast majority of babies, their blood clots just fine when necessary. And yet, it was decided in lofty scientific circles that if vitamin K supplementation is used to control such bleeding, its lack can be considered the cause. Certainly this simplifies the matter when doctors must explain to new parents why their baby needs an injection right away. And when the bleeding is described as potentially fatal, most parents, even those who are skeptical of official pronouncements, usually succumb to fear.
Are babies really so fragile?
Among accounts of bleeding in young children it is commonly found that the doctor tells the parents that any slight jolt to the head or even the body could have caused the problem. Some doctors even claim that simply placing the baby in the crib can jolt the baby’s head sufficiently to cause a brain bleed. There is no proof that this is the case; the vast majority of bleeding cases are considered “idiopathic” — of unknown origin.
Assuming that a newborn is so very fragile that the slightest tremor could cause internal injury is the more puzzling when one considers the birth itself. In a natural birth, the baby undergoes very considerable physical pressure even in births unassisted by forceps or a vacuum extractor. And yet, most babies come through just fine.
Some explain that, after birth, the circulatory system functions differently than during and before birth, making veins more sensitive. This is possible — but unproven. It is also possible that what many studies state is a better explanation:
When this type of spontaneous bleeding will occur is completely unpredictable, and it is not related to trauma, falls, or injury.
Three types of bleeding
According to modern medical authorities, there are three types of problematic bleeding pertaining to the young infant: early-onset, classical, and late-onset.
Early-onset bleeding occurs in the first 24 hours of a baby’s life after birth. It occurs almost exclusively in babies born to mothers who had been taking certain medications that interfere with vitamin K metabolism. These medications include anticonvulsants, antibiotics, antituberculosis agents, and warfarin, a medicine that prevents blood clots.
The clearest case for vitamin K supplementation can be made for these babies where the risk factors are known and the danger is considerable. It is worth pointing out that the “deficiency” of vitamin K here is artificially created. It is not a failure of God’s design.
So-called “classic VKDB” occurs between days 2 and 7 of a baby’s life. It is generally considered idiopathic, although bleeding during this time can be associated with liver dysfunction, problems with the bile duct, an inability to absorb vitamin K in the gut, and other causes.
Levels of vitamin K are thought to be at their very lowest during this period. The baby’s blood clotting factors are also in flux during this time, though they rise sharply around day 8, which “happens” to be when babies are circumcised according to Jewish law. Indeed, circumcising babies on day one or two of their lives, as happens in many American hospitals, may well be quite unwise.
Late-onset bleeding occurs between day 8 and six months of life. According to mainstream medical sources, the primary risk factors are exclusive breastfeeding and failure to supplement with vitamin K. Other risk factors include gallbladder disease, cystic fibrosis, chronic diarrhea, and use of antibiotics.
In low- and middle-income countries, the mortality rate of late-onset bleeding is very high; a quarter or more of babies who have such bleeding will die, and many who survive will be left with brain damage, due to bleeding in the brain. (We will address mortality rates in high-income countries later.)
It is generally accepted in mainstream medicine that the intramuscular vitamin K shot eliminates the risk of late-onset bleeding. Nonetheless, Pediatrics (the journal of the American Academy of Pediatrics—AAP) notes in a comprehensive article on VKDB that,
There have been no randomized trials evaluating the efficacy of early postnatal intramuscular vitamin K in eliminating late VKDB.
Surveillance studies, however, do show the injection to be effective in reducing the incidence of bleeding. The AAP recommends that all newborn infants receive a single IM dose of 0.5 to 1.0 mg of vitamin K after birth. That said, the AAP also writes that the level of vitamin K in the plasma of babies who are exclusively breastfed, between the ages of six weeks and six months, could still be low, even if the babies receive IM vitamin K. Therefore, they recommend that VKDB should be considered when evaluating bleeding in the first six months of life even in infants who received prophylactic vitamin K supplementation.
Formula vs. mother’s milk
Support for mother’s milk as best for babies is one welcome development in modern medicine. Formula is a very poor imitation in many ways. However, formula contains lots and lots of added vitamin K whereas mother’s milk contains relatively little. Does this matter?
The disparity is vast. Mother’s milk typically contains between 1 and 9 micrograms of vitamin K per liter, depending on various factors such as how well nourished the mother is. Indeed, recent studies have shown that the vast majority of bleeding cases in very young infants occur with nursing mothers who are very undernourished and/or have celiac disease.
Of course, not all mother’s milk is equal even in the same mother. The initial milk of a feeding contains less vitamin K; what is known as hindmilk (which a baby gets toward the end of a feeding, as long as the mother doesn’t juggle the baby from side to side) contains more. Significantly, colostrum, the gold-colored milk that is produced in the first few days of a baby’s life, is much nearer the 9 micrograms per liter than milk produced later. Many advise mothers to feed their babies very frequently during this time, at least every two hours. Studies have also shown that if the mother takes vitamin K supplements, the level of the vitamin in her milk will start to rise within hours.
All the same, 9 micrograms is still a lot less than the amount of vitamin K added to formula — between 50 and 100 micrograms per liter. A newborn drinks around half a liter of milk daily in the first few weeks. At an average of 6 mcg/L in mother’s milk, this gives him 3 mcg of vitamin K daily. By contrast, a baby on formula receives between 25 and 50 mcg each day.
Lots more vitamin K in formula, lots more vitamin K in diapers…
Does the nursing baby then get too little vitamin K, or the formula-fed baby too much, or is the truth somewhere in-between? A recent study notes that the amount of vitamin K added to formula was initially based on the vitamin K content of cow milk, and set at 60 micrograms per liter. Later research showed such a concentration to be far in excess of what a human baby needs — but formula milk manufacturers have not kept apace of scientific advances.
Where does all that excess vitamin K go? According to this study’s findings, vitamin K content of formula is approximately 40 times greater than that that of mother’s milk, and the fecal content of formula-fed babies has 38 times more vitamin K in it than the feces of breastfed babies. In other words, babies simply excrete all the excess and there is a great deal of it.
Does this put a strain on the immature liver of the newborn? One may perhaps assume so. Conclusive evidence is lacking. The study comments that, “Though there is no known toxicity associated with the current concentrations of vitamin K in infant formula, the high concentrations of unmetabolized PK [vitamin K1] in feces of formula-fed infants suggests formula PK content exceeds the absorptive capacity of the infant gut,” and that,
... the health implications of supraphysiological concentrations of PK in the infant are unknown.
Bacteria, C-sections, and vitamin K
That said, excess vitamin K in a baby’s body (whether due to an injection, or oral drops, or formula) may cause a variety of health issues beyond straining the liver. It is thought that excess vitamin K might interfere with the infant gut microbiota (bacteria in the intestinal system) — this is especially pertinent as vitamin K can actually be manufactured in the gut using intestinal bacteria.
Furthermore, while it is often assumed that babies are born with a “sterile” gut, containing neither good nor bad bacteria, this is far from the case. Thus, assuming that babies cannot manufacture their own vitamin K is a mistake. As the abovementioned study stresses,
Infants have low stores of vitamin K at birth ... the contribution of microbially produced vitamin K to infant vitamin K status is not well understood.
This study is particularly valuable as it compares not only breastfed with formula-fed babies, but also babies born naturally as opposed to delivered by C-section. What the researchers found was that babies born naturally have a higher gut bacterial capacity to produce vitamin K than those delivered by C-section.
This was no surprise finding to the researchers, as it has been known for many years that the transfer of gut bacteria from mother to baby is disrupted in C-section births. Indeed, doctors and midwives aware of this often “seed” bacteria in babies born by C-section by using cloths that have been inserted into the mother to swab the newborn immediately after delivery.
Disruption to the microbiome due to delivery mode has been associated with allergies and other health issues in children in numerous studies. Given that today around one in three births in the United States is via C-section, it is scandalous that there is not more awareness of these facts.
The study’s authors conclude that,
Further investigation into the role of gut bacterially produced MKn [vitamin K2] in early life nutrition and health is needed to understand how these early life practices influence the vitamin K status of the infant, either directly through the vitamin K content of the infant diet, or indirectly through modulation of the gut microbiome.
(Both vitamins K1 and K2 contribute to the clotting process; there is disagreement on which is more effective. Vitamin K3 is a synthetically produced imitation that was once used in newborn supplements, until evidence mounted that it caused liver damage and the destruction of red blood cells.)
There’s a problem, however. Is bleeding really down to the milk? When one set of researchers (Shearer 2009) investigated cases of late-onset bleeding in breastfed babies, they found that the mothers’ milk was not lacking in vitamin K compared to that of other nursing mothers whose babies did not bleed. They concluded that the problem was likely in the babies, not the milk, as they had problems absorbing vitamin K.
To be continued...
The information contained in this article is for educational and information purposes only and is not intended as health, medical, financial, or legal advice. Always consult a physician, lawyer or other qualified professional regarding any questions you may have about a medical condition, health objectives or legal or financial issues.