Sunday, July 06, 2008

Germany: No Fortification with Vitamin D

It recently occurred to me that German milk isn't fortified with vitamin D. Vitamin D isn't in a lot of foods, but you can get it from spending some time in the sun at the same times of day that you are normally told to avoid (due to skin damage/cancer risk), about 10am to 3pm. Luckily it only takes a bit of the sunlight, apparently, to trigger your body to make enough vitamin D, and you can avoid staying out too long and getting burned/damaged - even if you're lily-white like me. But what about cloudy days? How do Germans get enough vitamin D when the sun hasn't been out in a week? Do they just get extra when it IS sunny, to make up for it? (Vitamin D is stored in body fat and retrieved as needed from there.) Or is there fortified milk somewhere and I just haven't found it?

Germans are generally not into fortification, it seems. In addition to not having fortified milk, the only fortified cereals you can find are American brands. The other day I was snacking on a little bit of an American cereal in class (Toppas, which are the equivalent of Frosted Mini-Wheats) and a classmate asked me if I was still addicted to American food. I told her I was eating it because it was fortified with some things I have had trouble getting enough of in my diet. She made a horrible face at me and told me I could get it all from fruit. This after she had watched me eat bananas, watermelon, apples, carrots, and pineapples during class for the previous few days. I have trouble with iron, calcium, and magnesium - not with all the things you can get from fruit. However, you can get vitamin supplements in stores, so I guess Germans are not completely against unnatural sources of vitamins and minerals. It's better if it's in a pill than in cereal or milk?


  1. German children usually take a vitamin D and flouride supplement - called D-Flouretten - from the time they're born until about age 3 (I think, can't remember how long my kids took then) to make up for the lack of sunshine and the unflouridated water. After that people are left on their own although they do recommend 15 minutes of sunlight every day on the skin to build vitamin D.

    German doctors are also just now starting to get the idea that folic acid is a must for women who are pregnant or thinking about getting pregnant. When I asked my doc about it years ago he just shrugged and said I could get everything I needed from eating normal food.

  2. I got the impression milk with vitamin D here is drunk mainly by little kids. Adults rather take any supplements in form of pills than by eating the right stuff.

  3. Does it make a difference? (I'm glad to be asking this question of an epidemiologist.) I was trying to find information on vitamin d deficiency in Germany and in the US. My impression is that vitamin d deficiency is widespread both countries, but more so in Germany. However, it's not quite a fair comparison because of differences in sunlight, etc. Any thoughts?

  4. I was tought that Vitamin D (and K and ...?) is an "evil" vitamin because it is fat-soluble and stored and should only be taken in a controlled way if it's necessary.
    Water-soluble vitamins are the "good" vitamins you should take as much as you get because you cannot take an overdosage.

    You will see a lot of Vitamin C additions ("plus C" etc) or ACE is also common. Granted, I never in life even thought about my Vitamin D though knewing it exists ;)

    There also was an mediocre hype recently around an TV report about too much(!) fortificatons in children's food - mostly of stuff every kid should get enough of with normal foods.

  5. I just read an article about some research that was done on the use of vitamins that are chemically derived versus plant derived. As a result, I think if the additive is chemically derived, it is not as bio-available, and you should try to add the necessary foods to your diet... or take a plant derived supplement. Just my granola opinion though. :)

  6. Christina: Yes, I've read that folic acid supplementation rates in pregnant women are much lower in Germany than in the US. They are working on that, though. Americans might just be more open the idea?

    Bek: I don't recall seeing milk marketed separately for kids v. adults - I think most of it has vitamin D now. Of course since I am not actually living there, I might be misremembering now. :)

    Mary: Good question! I will have to look more into it though, because I haven't done too much. I'm not sure too many epidemiologists think about vitamin D, because I can tell you that every one of us spends lunch sitting in a neat little the SHADE. I did read that one of the cutoffs as far as being too far north to get it all from the sun is a line just north of Boston, making Germany almost entirely too far north.

    German Guy: You are right, D is fat soluble so you can get too much; however there aren't too many cases of that happening because people tend to be deficient rather than overdose. A and E are also fat-soluble, though, and as you mentioned there's sometimes juice/supplements available with those. It doesn't seem there's too much risk associated with overdoing E unless you're on blood thinners, but you can overdo A and there are a lot of side effects. Also, getting enough A in your diet is extremely easy (eat one carrot per day and you're done) so I can't see why fortification with that is done! (It's done in the US too of course!)

    Maria: The problem with Vitamin D is that there are virtually no good food sources. You really have to get it from the sun or a supplementation of some kind.
    If you ARE able to get EVERYTHING from your diet every day though, please give me tips!! The hard ones are calcium, B12 (we evolved a need for this from being exposed to our own feces, where it is found!! Not so easy nowadays!), magnesium, and iron! I have absolutely no problem with B6, C, A, niacin, etc etc.

  7. I think that very little sun exposure can produce enough vitamin D to last you through the cloudy days.
    I live in the UK (will be moving to Germany though in August)and I tend to avoid vitamin fortified products or supplements, when possible, as I don't really believe in them. My boyfriend is German and I know that his family take loads of supplement-cocktails! So, perhaps that's the German way of dealing with this.
    I think that a balanced diet should do the trick as the body usually takes what it needs when it needs it. I always wondered how so many generations survived without all these artificial supplements...

  8. > the hard ones are calcium, B12, magnesium, and iron!

    Standard German Mineralwasser. seriously. Typical Mineralwasser contains enough iron, calcium and magnesium to satisfy the daily need with around two liters (magnesium is a bit short, but you also get that from other stuff of course).

    B12 is aplenty in anything that contains animal protein (meat, innards, fish, eggs), vegan people have a problem with that of course.

  9. Most margarine and some soy drinks are fortified with vitamin D.
    Natural sources of vitamin D are fish, avocado, egg yolk, milk, cheese, butter, meadow mushrooms and even on cloudy days UV radiation reaches the earth. :-)

  10. I didn't mean that milk with vitamin D is sold separately for kids. It's just that when at the check out line I always notice families with several kids buying gallons of it. Families without kids seem to buy more the "normal" milk. But that's just my impression.

  11. I am a biologist by training. One of my former professors laughed when someone else asked him about supplements and said, "Sure - doesn't everyone want expensive pee?"

  12. I think there have been a number of studies that show that the decrease in sun exposure and a switch to unfortified milk in the US has led to a reemergence of long-forgotten vitamin deficiency diseases like rickets. In addition, women ought to worry about this since vitamin D appears to be involved in making bone and may be helpful for preventing osteoporosis. Although Americans may go a little overboard with the whole thing, vitamin supplementation has worked in the past to drastically decrease the incidence of vitamin-deficiency-related diseases, and measures like the vitamin D pills they give to young children in Germany seems like a valid way to combat this.

    Another vitamin deficiency that people might want to worry about, which was not the topic of the original post but was brought up later, is vitamin B complex deficiencies. I don't know if the flour in Germany is supplemented with vitamin B complex vitamins like it is in the US (the package doesn't say), but if it's not, then unless you drink a lot of Hefeweizen or eat a lot of fatty fish (or the right combination of meats and eggs), you're probably not getting the recommended daily doses of several B vitamins. That counts as a "deficiency" although I admit that I don't know how the USDA or the German institution involved in setting these standards came up with these numbers. Again, people (and women in particular) ought to worry about this since there aren't very many natural sources of vitamin B9--folate.

    Perhaps it would be an interesting exercise simply to track the amounts of vitamins one gets from their normal food sources and compare this with the RDAs (excluding Ca and Mg if you live in Germany and drink plenty of tap/mineral water ;) ). There are several sites on the interwebs that can do this, so it would be fairly easy.

    Comments such as "vitamin pills are only good for expensive pee" are distracting, not constructive, and tend only to stifle otherwise useful conversation (for example, how MIGHT one actually get all the vitamins they need?). As a fellow "biologist by training," I also heard comments like this occasionally in my biology and biochemistry courses, but I understood them to mean something very different--that is, the body gets rid of the excess vitamins it doesn't need, but it may be worth taking the vitamin supplement to make up for the vitamins that you DON'T normally get. Of course, this too is not entirely accurate since the body can't shed fat-soluble vitamins and overdosing on some of them (e.g. folate, vitamin A, beta-carotene) can be dangerous.

  13. Wow, lots of comments!
    I would love to discuss further about getting all your vitamins/minerals with you guys, Maria and Yelli. So if you're coming through Heidelberg sometime, let's meet up at Knoesel for Kaffee (or Tee, for me), Kuchen, and nutritional chit-chat. :) I think debating about it here, not in real-time, is too difficult. Of course, Damon, I can talk to you about this any time! :D

    Kato: I drink tap water, think the calcium in there is bioavailable? ;)

    Kato/Michael: Many of those are sources but don't give you 100%. I think my primary conclusion here is going to be that the USRDA recommended daily doses are actually a bit unrealistic, or they are realistic, but only for a 2500 calorie diet, perhaps.

  14. Sorry. It's been a crazy week at work and home. I promise to get back and comment further...

    In the mean time, I'm not saying don't take any vitamins-- just make sure the ones you do take are not chemically derived, but rather plant (etc) derived over chemical.

  15. Reading this post inspired me to take a multi-vitamin (although for the record, I am usually an advocate of getting vitamins from actual food - and not the fortified kind).

  16. uhh...sorry Damon. I was trying to be funny. Guess I should have put my scientist hat on instead of my (not) funny hat on.

    Yes, I agree that studies have shown that the body will get rid of excess vitamins that it doesn't need. Studies have also shown that some vitamins/minerals do not seem to be absorbed readily by the body through supplementation. I think they are finding that some nutrients are absorbed more readily than others and are not sure why.

    However, it looks like our host has asked not to debate it on her blog and I will respect that. I don't think I agree either way though so I wouldn't be much a debater.

    I will try to stick to my scientist hat from now on obviously. My funny hat must be broke or possibly still jet lagged... :)

  17. Aside from the great debate going on here...I am still laughing about the comment "are you addicted to American food?" You should have smiled and said, "'s addictive because of all the fortifications they add to it."

  18. Oops! Sorry I guess I didn't "hear" the tone in your post Yelli. I try not to overreact often, but when I do, I often totally misjudge the line. On a related note, I've always that that if politics moves to the realm of the internet, we're all screwed. Someone will get offended by some ironic remark made by someone country's leader in an email (and god knows how little time we have to edit those with all the emails we now get!) or a blog, and suddenly there'll be A-bombs going off everywhere. My love-hate relationship with the internet continues...


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