Exciting news everyone! After a lot of work over the last few months, our vitamin D calculator app for iPhone and iPad is finally live on Apple’s iTunes app store. It is a really cool app which allows you to easily estimate the daily intake of vitamin D from foods, multivitamins and casual sun exposure. It also connects you to a vitamin D calculator page on Facebook and Twitter.

Click on the link below for a free download! Don’t forget to rate and write a review.

photo credit: Naomi Ibuki

When it comes to getting vitamin D from food, salmon is popularly known as one of the best sources. The Office of Dietary Supplements, a department of the National Institute of Health, lists a 3 oz serving of salmon (sockeye) as having over 100% of daily value of vitamin D. Salmon is also a good source of omega-3 fatty acids, one of the healthy fats your growing child needs for brain development.

I was, therefore, very surprised when I looked at the nutrition facts panel of a can of pink salmon at the grocery store this weekend. It did not list any vitamin D at all!

How can it be when the common knowledge is that salmon provides a high level of vitamin D?

Turns out that not all salmon is created equal when it comes to vitamin D, or even other healthful nutrients. The problem seems to be an abundance of farmed salmon in our food supply, both in the fresh seafood section as well as canned and prepared meals.

As I researched this issue further, I came upon a scientific paper by Dr. Holick and co-workers from Boston University, who actually measured the amount of vitamin D in both wild salmon and farmed salmon. They found that the farmed variety contained 10-25% of the amount of vitamin D available in salmon. Dr. Holick explains the difference in this video, simply in terms of what the two feed on:

While the wild salmon could have as high as 1000 IU of vitamin D, the farmed variety contains about 250. There is also considerable debate about PCB’s, dioxins, antibiotics and artificial colors in farmed salmon.

Looking at it from the lower nutritional value and health/environmental risks, I am not sure if low price of farmed salmon is a good reason to make the choice. Not saying you need to give up on farmed salmon, but you certainly need to factor these issues in your purchase decision.

Another thing to keep in mind, vitamin D in wild salmon can vary in a broad range depending on the source and type. Ask questions and read the nutrition facts label before buying.

Here is a nice summary of the amount of vitamin D from various fish sources (Source: Holick paper)

©2011 Littlestomaks.com

All milk in the United States is fortified with vitamin D (1 cup = 25% daily value). So it is natural to think that yogurt and yogurt products should also have vitamin D. After all, they are all made from milk.

Not really.

Although, there is a trend now to add vitamin D to yogurt, there are still a lot of products out there with no vitamin D.  I decided to do a little research this weekend at the local Walmart. Here is a summary of what I found:

Yoplait original is the top of the pack with 50% DV of both calcium and vitamin D. The new packaging shows this fact prominently on the front of the box. Stonyfield is another good option but their Oikos brand organic greek yogurt does not have any vitamin D. Dannon, our long time favorite has a lot of catching up to do!

When I asked my Twitter followers about this, @peekababy informed me that the Yobaby and Yokids brands from Stonyfield also has added vitamin D. Sure enough, a quick check on their website showed that they have 25% daily value of vitamin D added to each serving.

With so much news on vitamin D deficiency, especially in kids, you would think that all yogurt brands would start fortifying their products with vitamin D.

What is in your yogurt? Take a peek inside your refrigerator and check if your yogurt contains vitamin D or not. Then leave a note below with the brand name and amount of vitamin D in each serving.

Disclaimer – I have not received any sponsorship or free samples of product for writing this review. For complete nutritional information check out the websites of these products.

©2011 Littlestomaks.com

photo credit: Lintilla

There is so much news about vitamin D deficiency these days that you have probably already considered taking a daily supplement to boost your vitamin D reserves. But did you know that taking a supplement is no guarantee that there will actually be an increase in your blood levels of vitamin D?

I was surprised to hear this from a friend over dinner this past weekend. He happens to be a physician, so the conversation was particularly worthy of attention. He shared that even after one year of taking a daily supplement, the 25-hydroxy-vitamin D level in his blood did not change. Even though this is the experience of only one individual, and may not apply to others, it is noteworthy.

Vitamin and mineral supplements are sold with a detailed list of each vitamin and mineral and their amounts on the package. The ingredient list shows the sources of these vitamins and minerals. But there is no information on how much will actually be absorbed in the body.

This is clearly quite disturbing. When the FDA approves a drug, they want to see all the data that proves its safety and effectiveness. Vitamins are not regulated, which means that they are not subject to this level of scrutiny.

What is your experience? If you are taking a supplement, or giving one to your child, have you considered this issue?

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

If you have a child with food allergies, naturally you worry if he is getting proper nutrition from his somewhat restricted diet. Perhaps you have considered giving a multivitamin but found yourself worrying about safety of those vitamins. This week, Registered Dietitian Brooke Schantz offers a few tips on what to look for when selecting a multivitamin for your child with food allergies.

Question: What kind of multivitamins are safe for my child with food allergies? What should I be concerned about?

Answer:

First, let me review the difference between a food allergy and food intolerance.  A food intolerance is an abnormal physiological response to food. Symptoms can affect the skin, respiratory tract, gastrointestinal tract (GIT) either individually or in combination. Some examples of symptoms of a food intolerance are gas, bloating, diarrhea, etc.  It can be difficult to determine the food that causes an intolerance because if the immune system is involved, the response takes place slowly. A food allergy is an immunological hypersensitivity which occurs most commonly in response to food proteins that are mistaken as harmful and therefore a defense system is created to fight them off. These allergic reactions have an acute onset (from seconds to one hour) and may include:  soft tissue, severe swelling of the tongue, hives, itching, nausea, vomiting, diarrhea, stomach cramps, nasal congestion, wheezing, shortness of breath, or anaphylactic shock.

Children with various food allergies would not be allergic to vitamins or minerals in supplements themselves; but rather to a possible ingredient used in the making of the multivitamins.  The Food Allergen Labeling Consumer Protection Act (FALCPA) was passed by the Food and Drug Administration (FDA) in 2006 to require manufacturers to identify the use of the top eight allergens.  These allergens are eggs, dairy, soy, tree nuts, peanuts, fish, shellfish, and wheat.  Unfortunately, vitamins fall under the category of “dietary supplements” which are not included in this law.  A dietary supplement is defined as products taken by mouth that contain a “dietary ingredient” intended to supplement the diet.  This is important to note, because vitamins are not meant to be a substitution for a healthy diet or justify consuming a poor diet.

The FDA does not approve dietary supplements prior to being put on the market.  Therefore, if your child is allergic to a specific allergen it is important to familiarize yourself with all the derivative names for that allergen.  For example, if your child has a milk allergy, you would also want to look for words on the ingredient label that include but are not limited to: calcium caseinate, casein, caseinate, rennet, curds, hydrolyzed casein, hydrolyzed milk protein, lactalbumin, lactalbumin phosphate, lactate, lactose, lactoferrin, and lactoglobulin.

What you can do:

1. Check the ingredients label for the specific food allergen and its derivative names.  Some vitamin labels even include information on common allergens, even though the manufacturers are not required to list this information. Below is an example children’s vitamin ingredients list.
   Ingredients: Sucrose, Sodium Ascorbate, Stearic Acid, Maltodextrin, invert sugar, Vitamin E Acetate, Corn Starch, Gelatin, Niacinamide, Magnesium Sterate, Natural Flavors, Yellow #6, Riboflavon, Thiamine, Folic Acid, Vitamin D3, Vitamin B12
   Contains: Soy
2. Look for the USP seal.  The U.S, Pharmacopocia (USP) is a non-profit organization that has established standards of quality for prescritpion and nonprescription drugs.  Using vitamins and other supplements with the USP seal indicates some quality of control.  Vitamins that have the USP seal can be found here.
3. Follow the dosage directions correctly!  Your child doesn’t need more than the recommended daily dose.  Some parents believe that if their child has eaten really poorly for one day giving an extra vitamin is better and this is not the case.   An overdose of certain vitamins could be dangerous and also lead to the preventing other vitamins from being properly absorbed.
4. Discuss the use of all supplements with your doctor and registered dietitian.

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

photo credit: treehouse1977

The summer is almost over and it is back to school time. Hopefully you got a chance to soak up the sun and enjoy some time off with your family. Chances are you were liberal with the sunscreen whenever you went out in the sun. That is definitely the conventional wisdom and there is nothing wrong with it. But did you know that getting some sun without the sunscreen is the best way of building up your child’s vitamin D reserves? Now I am sure you are worried about the damaging effect of too much sun on your child’s tender skin. But it does not take much to get a healthy dose of vitamin D.

I shook my head in disbelief when I read that even in sunny Florida, sub-optimal levels of vitamin D, and even deficiency of vitamin D, are quite common. On a recent discussion about vitamin D on LinkedIn, Diane Batshaw Eisman, MD FAAP wrote:

I am amazed that I find very low levels of Vit D here in Florida. I think we listen to the dermatologists and the natives avoid too much sun and then slather on the sunscreen.

There is some truth to the notion of slathering on the sunscreen because of the strong health advisory and heavy advertising by the makers of sunscreen. There is very little voice to the notion of getting your vitamin D from the sun. After all, who would want to risk advising people to stay out in the sun without sunscreen just to get vitamin D but end up getting melanomas?

Getting vitamin D from the sun appears to be a well kept secret! Experts have even developed a mathematical relationship between the amount of sun exposure and vitamin D. Holick’s rule is well known in the academic circles:

Sun exposure of 1/4 of a minimum erythemal dose (MED) over 1/4 of a body is equivalent to 1000 IU of oral vitamin D3

Minimum erythemal dose is the amount of energy required to produce the first visible sign of redness with clearly defined borders on your skin. In short, this is when you are about to get a burning sensation. The value of MED depends on the skin type – low for very fair skin and high for very dark skin. There are 6 different skin types defined based on the amount of pigment (fair vs. dark) and how easily it burns under the sun. The more popular UV Index is designed based on MED – for example, a type II skin will receive 1 MED within 20 minutes at a UV index of 10. To get a 1/4 of the MED, they would need to be in the sun for only 5 minutes, which means they can get 1000 IU of vitamin D3 in just 5 minutes with their arms and legs exposed without sunscreen! Consider this when the current recommended amount for toddlers is only 400 IU per day.

These calculations are not exact and actual exposure numbers may be different. The point is that it does not take much to get your daily quota of vitamin D3 from the sun. Of course, it is important to use good judgment and common sense not to overexpose the unprotected skin.

We live in a world where the solution to all our problems comes in a pill! For centuries, we have survived by getting this essential nutrient from the sun and diet – in fact, our skin color evolved in response to the amount of available sunlight. In the 21^st century, they now want you to believe that sunlight is too dangerous and that you should solve your vitamin D problem by popping a pill each day.

What do you think? Should the public health message about sun and sunscreen change?

©2010 Littlestomaks.com

photo credit: sly06

A recent article in the Pediatricss journal reported data on serum levels of 25-hydroxyvitamin D, the active form of vitamin D in blood and asked this question Do Children Need More vitamin D? There is a lot of buzz in the media these days about deficiency of vitamin D, especially in kids. Beyond the screaming headlines and soundbites, it is important to look at the data an scientific way before jumping to conclusions.

In this article,  I will first provide a brief background on vitamin D and explain why it is a concern these days especially for growing children. Second, I will describe the design of the Pediatric study and methods used to analyze data. Finally, I will summarize the results to support some of the key conclusions of this study.

Let me first say that there is no consensus on the threshold level of vitamin D in blood below which a child is considered deficient. Still, the authors concluded that millions of US children aged 1-11 years may have sub-optimal levels of vitamin D, especially non-Hispanic Black and Hispanic children. However, more research is needed before a decision can be made about recommending vitamin D supplementation in children.

Vitamin D – the sunshine vitamin!

Vitamin D is produced when our skin is exposed to the UV-B rays from the sun. That is why, sometimes it is also called the sunshine vitamin. It is also available from a few limited food sources such as milk, fortified orange juice and cereals, and fish such as salmon, mackerel, cod and herring. Vitamin D supplements are also available from both synthetic and natural sources. Deficiency of vitamin D is known to cause rickets, a condition which involves bone loss and deformation. Because vitamin D is also a prohormone, meaning it is involved in proper functioning of other hormones, recent research is linking vitamin D deficiency with many other diseases like diabetes, heart disease and even cancer.

Why the concern then? Well, the problem is that many parts of the world do not get enough sunlight through the year. When we do manage to get some sun, we have a tendency to overuse sunscreen because of the risk of skin cancer. Don’t stop doing that, but be aware that sunscreen blocks the UVB rays responsible for vitamin D production. As for nutrition, we know that children are picky eaters. They hardly eat fish or drink enough milk. Junk food has little vitamin D. Because of these reasons, there is a concern that kids are not getting enough vitamin D.

The Pediatrics study analyzed 2001-2006 NHANES data for kids 1-11 years old

Because of the concern over vitamin D, the Pediatrics article is very timely. Researchers from Harvard, Mass General Hospital and University of Colorado analyzed the NHANES data from 2001 – 2006, which is collected every 2 years by the National Center for Health Statistics. The NHANES uses a 4-stage sampling strategy to represent households across the country. It tends to oversample low income groups, blacks and Mexican Americans. However, statistical methods including appropriate weights are available to extrapolate the results to a nationally representative population.

In this study, the researchers obtained serum levels of 25-hydroxy-vitamin D – the “active” form of vitamin D present in the blood. They also had household interview data about the demographic, socio-economic status and vitamin use. Sample size for kids 6-11 years old from 2001-2006 was 3421 for household interview data and 2759 for serum 25(OH)D data. Sample size for kids 1-5 years old from 2003 – 2006 was 2677 for household interview data and 1799 for serum 25(OH)D data.

Serum levels were categorized as <25, <50 and <75 nmol/L. Although, there is no consensus on what constitutes as the level of deficiency in children, the Institute of Medicine has set it at less than 27.5 nmol/L while the Canadian Pediatric Society has set it at less than 25 nmol/L. Recently, a level of less than 50 nmol/L has been found to be linked to some level of bone demineralization.  In adults, recent studies demonstrated that healthy levels of serum 25(OH)D may be as high as 75 nmol/L or even higher. That is why, the researchers decided to look at prevalence data for the nationally representative population of 1-11 years old children at these 3 different levels.

Average blood levels do not show deficiency, but experts believe most kids have lower than desired level of vitamin D

The mean serum level for children 1-11 was 68 nmol/L. Children aged 6-11 had a slightly lower mean level at 66 compared to those aged 1-5 at 70 nmol/L.

When taken as a whole, following prevalence levels were found:
< 25 = 1%, < 50 = 18% and < 75 = 69%

In terms of actual population numbers, this translates to 320,000 children below less than 25, 6.3 million less than 50 and 24 million less than 75. If the “average” values of the serum level gave you a sense of comfort, simply look at these prevalence numbers. Amazing!

If you consider the level of 75 nmol/L or higher as optimal, like most experts, the prevalence of serum levels below 75 was higher for non-Hispanic blacks at 92% and Hispanic at 80% compared to non-Hispanic white children at 59%. In terms of numbers, 2 out of every 3 children in the US are below this level, and nearly all of the non-Hispanic black and Hispanic children are below this threshold. If the threshold is changed to <50, then over half of non-Hispanic black children 6-11 years old fall in this category.

The current daily recommended intake from the Academy of Pediatrics is 400 IU/day. Experts believe that this is insufficient to raise the serum levels to >50 or >75 and that vitamin D supplementation may be needed in at-risk populations.

More vitamin D is good for children, but do not jump to supplements right away!

Coming back to the original question “do children need more vitamin D”, the short answer is YES. It may be tempting to simply get on a daily supplement. But I think we should try to first make small changes in our lifestyle and eating patterns. Nature did not intend us to be deficient in vitamin D, even though she gave us all a different skin color. The fact that we see low numbers in our population is a result of our lifestyle and poor diet. Get active, get outdoors – even 10-15 minutes of sun exposure on your arms and legs without sunscreen is enough. Of course, you should worry about skin cancer and use sunscreen before it is too late. Get your kids to eat healthy including a diet rich in dairy and fish unless there is an allergy problem. There are many natural ways to ensure your child gets enough vitamin D before deciding to take a supplement.

Parents – are you concerned that your child may have a vitamin D deficiency? What steps are you planning to take? Share in your comments below.

©2010 Littlestomaks.com

FDA has issued a warning to parents about the risk of vitamin D overdose when using a liquid vitamin D supplement. It turns out that some products come with droppers that may allow an accidental overdose to infants. According to the FDA update:

…excessive amounts of vitamin D can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, and fatigue, as well as more serious consequences like kidney damage.

I think this is very a very confusing update! First of all, why does FDA allow such products with risky droppers in the marketplace? Secondly, what is excessive? Is there any standardization in dropper markings for infant vitamin D products? How can a parent tell if the dropper shipped inside the product packaging is the right dropper? What does the product labeling say about the safety and accuracy of the dropper?

So many questions are left unanswered in this update that I am surprised it was approved for publication!

Vitamin D is very important, especially for growing infants and children because it affects calcium absorption and bone growth. Now that there is so much news of vitamin D deficiency in infants and toddlers, parents are becoming ultra sensitive about it. When a warning like this comes from the FDA, it only adds to the anxiety. The FDA update does offer some recommendations, but I do not believe they offer enough guidance on safety or the level of risk.

The FDA supports the American Academy of Pediatrics recommendation of 400 IU of daily vitamin D supplementation for breastfed infants. It recommends parents to ensure that their infant does not receive more than 400 IU a day. The tolerable upper limit intake of vitamin D for infants birth through 12 months listed by the Office of Dietary Supplements of the NIH  is 1000 IU per day. That is 2.5 times more than what FDA is warning parents about. Further, adverse health effects are seen only after long term intakes above the tolerable upper limit.

What kind of a dropper is allowed to be packed inside a product which can dispense 2.5 times the recommended dose of any medication? I think that the FDA should also talk about what measures they are taking to ensure that unsafe droppers are not included in any product; not just infant vitamin D supplements. If the concern is so high, why not make sure that the maximum amount that can be dispensed from these droppers does not exceed 400 IU? Also, a list of potentially unsafe products should be made available to the public.

Parents – what do you think? If you are giving a vitamin D supplement to your infant or toddler, are you worried about this warning? What do you think the FDA should do?

Photo source: FDA’s warning update
©2010 Littlestomaks.com

There is a lot of buzz about vitamin D deficiency these days. According to some reports, 40% of US infants and toddlers are not getting enough vitamin D which increases their risk of a variety of health conditions. No doubt, vitamin D is very important for health,  especially for growing children. That is why it is good to pay attention to your child’s needs but there is no need to panic. In the past, I have written several articles on vitamin D including 5 ways to tell if your child may have a vitamin D problem. Here, a few quick facts about this important vitamin:

1. Vitamin D actually is a prohormone; which means that it is converted into a hormone inside the body. In this way, it is different from all other vitamins.
2. Vitamin D is produced when our skin is exposed to UVB rays from the sun.
3. There isn’t enough UV energy above 42 degree north latitude (a line between northern California and Boston) during November to February to produce any vitamin D in the skin. In places farther north, this can last nearly 6 months during the year.
4. Vitamin D from food or supplements comes in 2 forms – vitamin D2 or vitamin D3.
5. Vitamin D3 is 3 times more effective than vitamin D2 in maintaining blood levels of the active form of vitamin D.
6. Vitamin D is fat soluble and any excess from sun exposure or diet is stored in fat cells available for release when blood levels fall low especially during winter months. This does not, however, happen very easily in overweight or obese individuals.
7. American Academy of Pediatrics recommends a daily value of 400 IU for young children. You can get this amount from 4 glasses of milk or vitamin D fortified orange juice, 1.5 oz of cooked salmon, or about a third table spoon of cod liver oil.
8. Vitamin D deficiency causes rickets in children. Recent research indicates a link between vitamin D deficiency and diabetes, heart disease and certain types of cancers.
9. Blood levels of less than 20 ng/ml are considered to indicate vitamin D deficiency.
10. Mushrooms when exposed to UV light during production are rich in vitamin D2.

Source: Vitamin D Dietary Supplement Facts Sheet from NIH

Just like thiamin, riboflavin and niacin, which I wrote about recently, Pantothenic acid is another B vitamin commonly known as the B complex. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Pantothenic Acid?

Pantothenic Acid is also known as vitamin B5, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Pantothenic Acid, like the other B vitamins, is soluble in water. The name pantothenic acid is derived from the Greek word pantothen, which means from everywhere! Clearly, it is an essential component of all plant and animal life. Inside the living cells, it is found in the form of coenzyme A (CoA). A coenzyme is a kind of a “helper molecule” inside our cells which attaches to an enzyme involved in a variety of biochemical reactions. In some ways, living cells are like tiny factories where these biochemical reactions take place and enzymes are responsible for speeding up those reactions.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, pantothenic acid is involved in a number of biological reaction, including the production of energy from carbohydrates, fatty acids and amino acids. It is also required for production of cholesterol, steroid hormones and neurotransmitters. Even though we hear cholesterol as a bad word and something to be avoided, there is also good cholesterol that our body needs.

Coenzyme A is also required for production of the neurotransmitter acetylcholine and the hormone melatonin. It also plays a role in making heme, which is a component of hemoglobin. In short, it does a lot of important things inside the body which are needed for sustaining life and healthy growth.

How much pantothenic  acid should my child be getting?
What are good sources of pantothenic acid?

For infants, the FDA has recommended a daily amount of 3 mg. And for toddlers less than 4 years old, the recommendation is 5 mg. Pregnant and nursing women are recommended to take about 10 mg per day. Healthy adults are also advised to take about 10 mg per day.

Pantothenic acid is usually present in organ meats (liver, kidney), egg yolk, avocados, cashew nuts, peanuts, brown rice, soya, lentils, brocooli and milk.  Here are a few examples of different food sources and amount of pantothenic acid per serving (source: wikipedia and Linus Pauling Institute):

1. Avocado, 1 whole = 1.9 mg
2. Chicken, 3 oz, cooked = 0.98 mg
3. Lentils, 1/2 cup, cooked = 0.6 mg
4. Milk, 1 cup = 0.8 mg
5. Cod fish, 3 oz, cooked = 0.15 mg
6. Broccoli, 1/2 cup = 0.48 mg
7. 1 Large egg = 0.61 mg
8. Yogurt, 1 cup= 1.35 mg
9. Sweet potato, 1/2 cup = 0.88 mg
10. Whole wheat bread, 1 slice = 0.19 mg

What happens if my child does not get enough pantothenic acid?

According to the PDR for Nutritional Supplements, pantothenic deficiency is rare. The symptoms, which are seen under severe malnutrition, include numbness in the toes and painful burning in the feet.

Should I be concerned about pantothenic  acid deficiency?

The short answer is NO. As long as your child’s diet includes a variety of food sources such as meats, dairy and vegetables, you have no reason to worry. There is no need to use a supplement. Whole grains are good source of pantothenic acid and other vitamins. Eating too many refined grains is a problem not just for pantothenic acid, but for other nutrients as well. Therefore, introduce your family to whole grains for a variety of benefits. Most breakfast cereals are not fortified with pantothenic acid although they contain other B vitamins. Balance, variety and moderation in your child’s diet is the best strategy for getting essential nutrients.

What do you think? What changes, if any, would you consider making to your child’s diet so he gets enough B vitamins?

©2010 Littlestomaks.com

Wall Street Journal reported last week that sales of children’s supplements in 2008 were around $1.1 billion and growing at 4-6% each year. This is the first time data is available for kids supplements, although there is little doubt that multivitamins and mineral supplements are a big business. Just look at the amount of space they occupy on the shelf at a typical supermarket!

I am sure the question has come to your mind – should you give your child a supplement?

The position of the American Dietetic Association, which I agree with completely, is that food should be the primary source of vitamins and minerals your child needs. In general, it is very unlikely that your child has a strong need for additional supplementation even if he is a picky eater or does not seem to eat enough fruits and veggies! The Wall Street Journal article cites a study of 1847 pre-schoolers in Belgium which suggested that both supplement users and those who did not take them were often meeting their nutritional needs through food alone with the exception of vitamin D.

Having said that, there are situations where you do want to discuss the subject of supplements with your pediatrician. In 5 Reasons To Consider A Multivitamin Supplement, I wrote about a few of these situations:

1. If you are exclusively breastfeeding (0-24 months)
2. If your child’s diet is primarily vegetarian (2-5  years)
3. If your child does not eat enough fruits and veggies (2-5 years)
4. If you have a picky eater (2-5 years)
5. If your child’s growth profile is slower than normal (2-5 years)

The keyword here is consider - which means you should research this option and bring it up for discussion with your pediatrician or dietitian. Some experts believe that a majority of children today need some kind of supplementation, most frequently vitamin D, probiotics and omega-3, to fully optimize their nutrient intake. That may or may not apply to your child. It is very important to look at your child’s health history and growth profile over a long period of time. Just because he has become a picky eater over the last few weeks and does not eat any fruits and veggies is not enough of a reason to jump on the supplements bandwagon!

There is another aspect to supplement use. I wrote about another study of over 10,000 children 2-17 years old which concluded that kids who really need vitamins don’t get them. The point was that children from affluent households with a fairly good health profile were the biggest consumers of supplements.

In other words, parents are giving supplements to their children just in case and that they do not think there is any risk. Clearly, supplement makers focus on this behavior with their marketing and product mix. The problem is that there can be a downside if you are not careful. Here are a few possibilities -

1. Risk of overdose, particularly vitamin A which can cause liver problems and lower bone density
2. Overdose of iron can be fatal
3. Zinc overdose causes copper deficiency which can cause anemia (low red blood cells)
4. Poorly balanced formulation with respect to your child’s needs
5. One product containing high amount of selenium caused vomiting and diarrhea
6. Unknown impurities, sugar, artificial colors

The fact remains that unlike pharmaceuticals, nutritional supplements are not rigorously regulated by the FDA. Some rules do exist and the FDA has the power to force product recalls, but it is only when there is a reported problem. As a result, a few bad products actually manage to slip through the cracks.

Bottom line: Treat vitamins and other supplements like drugs and use them only after consulting with your doctor. Choose a quality product with high purity ingredients (look for the USP seal).

Are you using a supplement with your child? Share your reasons and the type of supplement in comments below.

©2010 Littlestomaks.com

Just like thiamin and riboflavin, which I wrote about recently, niacin is another B vitamin commonly found in fortified foods such as cereals, breads from enriched flour, pasta, sauces, baby foods, energy drinks. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Niacin?

Niacin is also known as vitamin B3, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Sometimes, the word niacin is also used for nicotinic acid and nicotinamide or niacinamide. It can get very confusing, especially because most fortified foods contain nicotinamide as a nutritional supplement and the ingredient list may not explicitly show niacin. Although they are chemically different, the thing to remember is that they all do pretty much the same thing inside the body.

Niacin, like the other B vitamins, is soluble in water. Just like riboflavin, niacin is also involved in production of energy at the cellular level. It is also responsible for synthesis of fatty acids, cholesterol and steroids. Even more importantly, it is involved in gene expression, that is production of proteins when genes become active. When taken as a medical treatment, niacin lowers bad cholesterol (LDL) and increases good cholesterol (HDL) and reverses the clogging of arteries. Of course, you should not rely on supplements to achieve this effect if you have a cholesterol problem; you need to see a doctor!

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, niacin is involved in the conversion of carbohydrates, fat and protein into energy required for cell functions. It plays an important role in regulating your child’s metabolism and growth.

There is some recent research which shows a preventive effect of nicotinamide for type I diabetes. The data is far from conclusive, so you should talk to your doctor if you suspect your child might have a risk of type I diabetes because of family history or another medical condition.

How much niacin should my child be getting?
What are good sources of niacin?

For infants, the FDA has recommended a daily amount of 8 mg. And for toddlers less than 4 years old, the recommendation is 9 mg. Pregnant and nursing women are recommended to take about 20 mg per day. Healthy adults are also advised to take about 20 mg per day.

Niacin is usually present in meat, poultry, yeast, fish (salmon, tuna), whole grains, fortified cereals, breads made from enriched flour. Leafy green vegetables and milk also provide some niacin.  Here are a few examples of different food sources and amount of niacin per serving (source: wikipedia and Linus Pauling Institute):

1. Chicken, 3 oz (deck of cards), cooked = 7.3 mg
2. Turkey, 3 oz = 5.8 mg
3. Salmon, 3 oz = 8.5 mg
4. Fortified breakfast cereal, 1 cup = 5 mg
5. Portabella mushrooms, 3.5 oz = 3.6 mg
6. Lentils, 1 cup = 2.1 mg
7. Hazelnut, 100 g = 1.5 mg
8. Peanuts, 1 oz = 3.8 mg
9. Broccoli, sweet potatoes, carrots = 0.6 – 1.2 mg
10. Avocado, 100 g = 1.7 mg

It is not common  to get excessive amounts of niacin from food sources.

What happens if my child does not get enough niacin?

According to the PDR for Nutritional Supplements, niacin deficiency causes pellagra, which these days is very rare in the developed countries. In the old times, pellagra was a condition that resulted in dermatitis, dementia and diarrhea and even death.

Should I be concerned about niacin deficiency?

The short answer is no. There is a risk with corn rich diets unless the corn is processed in a certain way to release the niacin from its bound form. Too many refined carbohydrates, unless enriched with niacin – which they commonly are – can also present a risk. If you have known problems with digestion and absorption of food,  your doctor can advise a proper treatment including supplements.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough niacin?

©2010 Littlestomaks.com

Just like thiamin, which I wrote about recently, riboflavin is another B vitamin commonly found in fortified foods such as cereals, enriched flour, pasta, sauces, baby foods, energy drinks.  In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. I am following up on my article on vitamin A from a few weeks ago. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Riboflavin?

Riboflavin is also known as vitamin B2, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Riboflavin, like the other B vitamins, is soluble in water. Cells in our body need energy produced by special biochemical reactions. Certain types of enzymes help these reactions happen, but they too need help from coenzymes produced by riboflavin. Obviously, this is very complex chemistry, but the point is that riboflavin is an important player in the chemical reactions that produce energy at the cellular level. Recently, high doses of riboflavin have been found effective in preventing migraine headaches. Seek medical advice before using riboflavin for migraines.

It is also used as a food coloring because of its yellow or yellow-orange color. The more soluble riboflavin 5′-phosphate is called the E101 food color.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, riboflavin is involved in the conversion of carbohydrates, fat and protein into energy required for cell functions. Riboflavin also has antioxidant activity which protects your body from reactive oxygen radicals. Just like the other B vitamins, riboflavin plays an important role in your child’s metabolism.

How much Riboflavin should my child be getting?
What are good sources of Riboflavin?

For infants, the FDA has recommended a daily amount of 0.6 mg. And for toddlers less than 4 years old, the recommendation is 0.8 mg. Pregnant and nursing women are recommended to take about 2  mg per day. Healthy adults are advised to take about 1.7 mg per day.

Riboflavin is usually present in most plant and animal food sources although in small amounts. Yeast extract is exceptionally rich in riboflavin, and organ meats like liver and kidney are also good sources. Here are a few examples of different food sources and amount of riboflavin per serving (source: wikipedia and Linus Pauling Institute):

1. Cooked spinach, half cup = 0.2 mg
2. Asparagus, about 6 spears = 0.14 mg
3. Almonds, cooked, 1 cup = 0.8 mg
4. Fortified breakfast cereals, 1 cup = 0.5 – 2.0 mg
5. Milk, 1 cup = 0.34 mg
6. Egg, cooked, 1 large = 0.27 mg
7. Cheddar cheese, 1oz = 0.11 mg
8. Fish, salmon or halibut, 3 oz (deck of cards) = 0.1 mg
9. Chicken/beef, cooked, 3 oz = 0.16 mg
10. Bread, whole grain or enriched flour, 1 slice = 0.08 mg

Riboflavin is destroyed by ultraviolet light. As you can see, riboflavin is naturally available in many common food sources. There is really no need to look for a nutritional supplement for riboflvain although you will find many multivitamin products on the market. Check out my review of some of the popular kids brands of multivitamins.

Riboflavin is well tolerated without any adverse effects. There is no reason, however, to take a high dose of riboflvain supplement.

What happens if my child does not get enough riboflavin?

According to the PDR for Nutritional Supplements, riboflavin deficiency (also known as ariboflavinosis) can cause any of the following conditions:

1. Cracked or sore lips, especially on the outer corners
2. Sore throat, redness or swelling of the lining of the mouth
3. Magenta tongue
4. Skin lesions, dermatitis
5. Poor iron metabolism and absorption, lower hemoglobin levels
6. Vascularization of the cornea

These symptoms are medical conditions and should be interpreted by a doctor. It is not common for riboflavin deficiency to occur in isolation. Usually it happens when a lot of other vitamins are also absent because of poor nutrition, digestive disorders or other medical conditions.

Should I be concerned about riboflavin deficiency?

Since riboflvain is commonly available in many foods and cereals, it should not be a big concern. However, if your child’s diet is mainly junk food and not enough whole grains, nuts, fruits and vegetables, you may want to pay attention to his overall vitamin B needs.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough riboflvain? Do you have recipes that use food sources rich in riboflavin? I would love to hear from you!

©2010 Littlestomaks.com

If you read nutrition facts labels, especially on breakfast cereals, you may have noticed thiamin in the long list of vitamins and minerals. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. I am following up on my article on vitamin A from a couple of weeks ago. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Thiamin?

Thiamin is also known as vitamin B1, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Thiamin, like the other B vitamins, is soluble in water. It was one of the first chemicals to be considered a vitamin early in the 1930′s when researchers discovered that thiamin deficiency caused beriberi (also known as extreme weakness). People with beriberi have difficulty standing, walking and controlling their muscles.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, Thiamin is involved in the conversion of carbohydrates into energy required for cell functions. It also helps convert some of the amino acids into proteins.

How much Thiamin should my child be getting?
What are good sources of Thiamin?

For infants, the FDA has recommended a daily amount of 0.3 – 0.5 mg. And for toddlers less than 4 years old, the recommendation is 0.7 mg. Pregnant and nursing women are recommended to take about 1.7 mg per day. Healthy adults are advised to take about 1.5 mg per day.

The best sources of Thiamin are whole grain foods and fortified cereals. Most cereals are fortified thiamin hydrochloride and thiamin mononitrate (check the label). Here are a few examples of different food sources and amount of thiamin per serving:

1. Whole wheat bread, one slice = 0.1 mg
2. Brown rice, cooked, 1 cup = 0.19 mg
3. Enriched white rice, cooked, 1 cup = 0.26 mg
4. Fortified breakfast cereals, 1 cup = 0.5 – 2.0 mg
5. Lentils, cooked, 1 cup = 0.17 mg
6. Pork chopped, cooked, 3 oz = 0.8 mg
7. Orange juice, 1 cup = 0.1 mg
8. Sunflower seeds, 1/4 cup = 0.8 mg
9. Spinach, cooked, 1/2 cup = 0.09 mg
10. Wheat germ cereal, 1 cup = 4.47 mg

As you can see, thiamin is naturally available in many common food sources. There is really no need to look for a nutritional supplement for thiamin although you will find many multivitamin products on the market. Check out my review of some of the popular kids brands of multivitamins.

Research has not shown any harmful effects of overdose of thiamin from foods or supplements. Oral thiamin is well tolerated upto 200 mg daily or higher (it is over a 100 times more than the recommended value). There is no reason, however, to take a high dose of thiamin supplement.

What happens if my child does not get enough thiamin?

According to the PDR for Nutritional Supplements, thiamin deficiency can cause any of the following conditions:

1. Cognitive and emotional changes – in short, it may affect memory and mood.
2. Although anemia (decrease in number of red cells) is not a direct result of thiamin deficiency, certain kinds of anemia respond well to thiamin treatment. It is understood this could be due to reduced absorption of thiamin or problems in conversion of thiamin inside cells.
3. Extreme deficiency of thiamin causes beriberi. Dry beriberi affects the muscles in the lower legs and feet. Wet beriberi involves the heart and blood circulation. The most extreme form of wet beriberi is called Shoshin beriberi, which can result in death if not promptly treated. Another form of beriberi is cerberal beriberi (Wernicke-Korsakoff) which affects the nervous system and causes problems with eye movement and even mental health.
4. Although not well-researched, some people think that thiamin deficiency may be involved in ADHD.

Thiamin deficiency is generally a problem with severe sustained malnutrition and alcohol abuse. Most healthy kids and adults with normal eating habits and lifestyle should not have to worry about it.

Should I be concerned about thiamin deficiency?

Since thiamin is so commonly available in many foods and cereals, it should not be a big concern. However, we live in the world of fast food which is usually made from refined carbohydrates. Refined carbohydrates, unless enriched, do not contain enough thiamin. In fact, the reason why they found out about beriberi was because it was first seen in people of Asia who mainly ate polished rice. If your child’s diet is mainly junk food and not enough whole grains, nuts, fruits and vegetables, you may want to pay attention to his vitamin B needs.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough thiamin? Do you have recipes that use food sources rich in thiamin? I would love to hear from you!

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Liz Marr explains why you need to exercise caution when considering a multivitamin for your child.

Question: How important is taking daily multivitamins and when should kids start?

Answer:

While parents may worry that their toddlers are not taking in adequate nutrients, normal, healthy children, even picky eaters, typically don’t need multivitamin supplements. According to the American Dietetic Association, the best strategy for meeting nutritional needs, for children and adults alike, is eating a wide selection of nutritious foods. Studies suggest that positive health outcomes are related more to overall dietary patterns rather than intakes of individual nutrients. Foods contain an array of health-promoting substances beyond vitamins and minerals, for example flavonoids.

Parents believe supplements provide children nutrients that may be lacking in their diets, according to research. However, by introducing supplements at an early age, parents may be unwittingly sending the message to children that supplements are a substitute for healthful eating patterns.

No solid evidence exists that children’s health is improved by multivitamin supplements. Nonetheless, about one third of children in the United States take multivitamin supplements. However, that figure is down from the 1970s. Compared to infants and adolescents, children ages 4-6 are most likely to take supplements. Interestingly, national surveys suggest that supplements may be taken by those who have healthful diets and lifestyles more often than those at a greater risk for vitamin and mineral inadequacies.

Because many foods that are consumed by children are already fortified with various vitamins and minerals, children are probably consuming more nutrients than parents might think. For example, many foods common in children’s diets are typically fortified, including breakfast cereals, breads, dairy products and juices.

One nutrient for which some infants and children may require supplementation is vitamin D. Because of the role of vitamin D in healthy bone formation, the American Academy of Pediatrics recommends 400 IU of supplemental vitamin D for the following:

• Breastfed infants
• Non-breastfed infants consuming less than one quart of vitamin D-fortified formula
• Children consuming less than one quart of vitamin D-fortified milk
• Adolescents with intakes less than 400 IU per day.

So, if parents choose to give children multivitamins, they should make sure the supplement contains vitamin D.

A particular caution with keeping multivitamins (children’s or adult’s) in the house with young kids, is risk of overdoses. Of particular concern with multivitamins is iron, an overdose of which can be fatal. Many children’s vitamins are designed for kid appeal, available in a variety of colors, flavors and branded characters. And children may view them as candy. If parents choose to keep multivitamins in the house, the supplements should well out of reach of young children.

©2010 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.