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

Greetings! This month, the American Dietetic Association is running its National Nutrition Month® campaign. It is a public awareness program designed to focus attention on the importance of making informed food choices and developing sound eating and physical activity habits. This objective is very much aligned with the focus of Littlestomaks because we are all about helping parents of toddlers make smart choices about their child’s nutrition and lifelong healthy eating habits.  That is why I will be supporting this campaign by writing articles along this year’s theme of Nutrition From The Ground Up. I would like to call upon my fellow nutrition and food bloggers to do the same! I am also open to ideas if you want to collaborate!

It is Friday again, which means it is time for the usual Five for Fridays! Here are 5 nutrition related articles that caught my eye. Enjoy and do share your opinion in the comments below.

Link between childhood obesity and heart disease gains strength

30% of obese 3-5 year old children show higher levels of C-reactive protein (CRP), which is linked to inflammation and is known to predict heart disease and stroke. This is nearly twice the rate at which high levels of CRP are seen in children with healthy weight. This data is based on a recent study of 16,000 children between the ages of 1-17 published in the journal Pediatrics and cited in this week’s Wall Street Journal.

It does not mean that children who show high levels of CRP will definitely develop heart disease when they become adults. This is because CRP can be elevated due to a lot of other reasons. Still, this is a strong link between obesity and heart disease and suggests that early childhood obesity needs our immediate attention. The question I would like to get answered is if these high levels of CRP can be reversed in obese children if their weight is managed as they grow. If I find out, I will write about it!

Flooded by snacks, kids are becoming constant eaters

Kids get 27% of their daily calories from salty, fatty and sugary snacks and constant nibbling starts as early as 2! This is what a recent snacking study found from surveys of over 31,000 kids. Clearly, this is becoming a big challenge for most parents who are trying hard to encourage their kids to develop healthy eating habits. Availability of all kinds of snacks combined with our culture of bringing something to eat for every event means that kids are constantly munching.

I think the main problem is that there is no separation anymore between a regular meal and snacks – which are supposed to manage our hunger level between meals and not act as a substitute. To that end, it is important to drive an understanding – and acceptance – of this notion of separating meals from snacks at an early age. And of course, we as parents have to be a role model by consistently showing the desired behavior.

It is not about healthy snacks, although a lot of products claim to be just that. It is about healthy choices which kids should be empowered to make right from the start. If they recognize their hunger cues, and are in the habit of eating full, wholesome meals at regular times, I am sure they will be able to manage snacks on their own.

If you are facing this situation, check out these handy tips on managing snacks and treats by one of our experts.

Confused about which diet to pick? Get your genes checked!

We have all heard about low-carb and low-fat diets, and you have probably tried them all! If nothing seems to work, check out this new technology of a genetic test for diet. It may just point you to the right direction!

It is yet another weapon in our fight against overweight and obesity. Now you can find out if you are genetically predisposed to lose weight on a low carb diet or on a low fat diet. In a study of 133 overweight women, a substantially higher weight loss was reported when their diet was matched with their genetic predisposition. A separate study shows that 45% of white women have the low carb genotype while 39% have the low fat genotype. The test looks at variations in 3 genes known to affect metabolism of fat and carbohydrates.

Don’t run out to get this test yet because these results are far from conclusive. More research is needed especially with a larger group of men and women across different racial demographics. It is an important trend however, we are finally in the era of personalized medicine and nutrition!

FDA issues warning letters to rein in food labels

This week the FDA issued several warning letters to 18 food companies including high profile names such as Nestle, POM Wonderful and Beech-nut. The big guns are out to shoot down the front-of-box claims, which according to some, are getting out of control these days. There are some, including the prominent Marion Nestle, who are suggesting an outright ban on these front-of-box labels.

If you look closely at the reasons for most of these warning letters you will notice something interesting. FDA is complaining that labels like “low sodium”, “low fiber”, “plus vitamins and minerals” are not allowed on products intended for children 2 years or younger because appropriate dietary levels have not been established for children in this age range. Now whose fault is that? Clearly, inaction from the FDA has created a vacuum which is being filled by savvy marketers. It is also clear that there is a need for front-of-the box labels. Busy consumers do not have time to read and absorb the Nutrition Facts and ingredients list on the back or side panels. They want something quick that helps them decide whether they should buy a certain product or not.

The rest of the world is already moving ahead with standardizing front-of-box labels, an example of which is the traffic light food labeling system. There is no perfect answer, but we need something that works. I hope the FDA takes this on and not simply try to appear like they are doing something by issuing warning letters!

Big Words from Little Foodies

Finally a shout out for my blogger friend Jenna of KidAppeal, who is running a weekly column on her blog called Big Words from Little Foodies. She is inviting toddler parents to share mealtime funny comments they hear from their kids in response to the food on the table. We have had a lot of fun lately with our twins as we try to engage them with funny stories and watch their response! Check out stories from other parents and recipes they have shared as part of this column. We too have contributed to it with articles like diesel food for a diesel engine and eating salad like a giraffe! Share your stories of mealtime fun in comments below.

Enjoy and let me know what is on your mind.

Photo Source: just jane on Flickr via everystockphoto
©2010 Littlestomaks.com

The author of this book Michelle May, M.D., is a contributor to my Ask the Expert column. That is why when she told me that she had published this book, I was immediately interested even though it did not directly apply to toddlers. I think Dr. May has a very interesting thesis here which flies in the face of typical advice on diet and weight loss. Her own personal and professional experience make it all the more credible. No wonder, it was hardly a surprise to me when she told me that this book was recently selected by TIME.com as one of the Top 10 Notable New Diet Books of 2010 and won the National Book Award for Best Health Book! I am so happy for her and wish her continued success.

Overview

Dr. May’s main message in this book is for you to answer a simple question Am I Hungry? It is amazing that children know this notion very well and eat only when they are hungry. Yet, adults no longer have that sense because they tend to eat in response to their emotional needs, not necessarily the sensation of hunger. In this book, she teaches the notion of the Eating Cycle and explains what it means in the case of overeating, restrictive eating (diets) and instinctive eating (eat when hungry and stop when full). The eating cycle is based on 6 fundamental questions – Why, When, What, How, How Much and Where – which will help you determine your eating patterns and underlying drivers.

In short, she wants you to develop a clear understanding of your own personal eating cycle, and not simply obsess over what you eat and how much you eat.

That is why the title of her book is so powerful. Once you understand your own eating cycle, you can pretty much eat what you love without feeling guilty. Balance, variety and moderation along with awareness of where you are on the Hunger-Fullness scale will help you get to the weight you desire and, more importantly, stay there.

Here are a few practical tips I really liked in this book -

• Great point of view on mindful eating – it means eat with intention and eat with attention
• A very practical and intuitive Hunger and Fullness scale to help you judge when you need to eat. I also liked the balloon analogy. Bottom line, eat when you are hungry, don’t wait until you are starving and stop eating when you feel full and not stuffed!
• Each chapter ends with a list of strategies you can immediately apply.
• The FEAST method to understand why you feel like eating when you are not hungry (Focus-Explore-Accept-Strategize-Take Action)
• Strategies to deal with difficult emotions, particularly anger, and not let them lead to overeating.
• Triggers for overeating and how to recognize them.
• Provides a tool to understand feelings and how they drive actions – TFAR (Thoughts-Feelings-Actions-Results)
• Very good overview of the fundamentals of nutrition in common sense language – carbs, fats, proteins, vitamins, metabolism etc.
• The whole book is sprinkled with nuggets of wisdom called Mindful Moments – very practical, scientifically balanced nutrition advice.
• Personal stories from clients and Dr. May’s analysis and advice based on principles of mindful eating.
• Collection of healthy recipes with practical suggestions under Chef’s Notes, Doctor’s Notes and Family Notes.

10 things I learned from this book I did not know before

1. High-fat, high-sugar processed carbohydrates can temporarily activate the pleasure centers in the brain by triggering the release of serotonin and beta-endorphins. No wonder, they are so addictive!
2. Hormones produced when you feel stressed actually accelerate storage of fat.
3. Your taste buds are most sensitive when you are hungry and when you start eating. That is a great tip for fully enjoying the food – eat when you are hungry!
4. Medical research has proven that even a 5% weight loss can significantly improve your health! Small is indeed beautiful!
5. Many people are chronically dehydrated and don’t even know it!
6. Excessive salt can lead to more water retention.
7. The more you weigh, the more fluid your body needs.
8. Basal metabolism consumes the largest portion of energy. Basal metabolism is the amount of energy (calories) your body needs to support vital bodily functions like heartbeat, breathing, brain function, even eating and digesting.
9. Muscle cells burn more energy than any other type in your body. They also require more energy for maintenance.
10. The American Heart Association recommends that you limit your intake of saturated fat to less than 7% and trans fat to less than 1% of your total daily calories.

What I did not like so much

• I think a 10-point scale for assessing the sensation of hunger or fullness may be a little difficult for most people to fully internalize because it is hard to tell a 1 – 2  point difference. For me, the balloon analogy for your stomach of 1 being empty, 5 being a gentle natural shape and 6-10 being overstretched works better. The scale could be simpler with only a 4-5 levels.
• There are a lot of tables and sometimes the information tends to be repetitive.
• I would have loved to see a chapter on how you can apply these principles not only to yourself but to your whole family including children.
• I love pictures, so it would have been nice to see pictures of the recipes.

Recommendation

I think Dr. May’s book is based on a very powerful idea, one that asks you to be first in tune with your inner self instead of prescribing a miracle diet. This book is a great resource for anyone trying to not simply lose weight, but change their entire outlook on food and eating! I think this book can be very effective if you:

• fully understand the fundamental principles of mindful eating first
• make an effort to apply the tools – Hunger/Fullness scale, FEAST, TFAR etc
• practice strategies for mindful eating
• keep a journal to track your progress

This is not a quick read rather a handy reference that should occupy a prominent and rather permanent place on your bookshelf.

Overall, I give it a big thumbs up! Visit Eat What You Love, Love What You Eat to download the first chapter, read other reviews, listen to an interview and learn how to order.

Leave me a comment if you found this review useful.

©2010 Littlestomaks.com

Hello everyone! Seems like I still can’t let go of summer – this picture was so cute, I had to post it this week to remind us of summer fun on the beach. We did manage to get out a few times to the nearby beach, although my daughter refuses to step on the sand! She finds it too yucky – go figure!! Luckily both of our twins love the pool, so that is where we spent most of our summer this year.

It’s Friday, which means it’s time for another Five for Fridays! Here are 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

Finally some guidance on daily sugar intake for Americans

I almost fell out of my chair when I read that Americans consume a whopping 22 teaspoons of sugar every day. That is about 355 calories, nearly 20% of the 2000 recommended daily caloric intake. I am sure you have noticed that on a typical nutritional facts label, there is no daily percentage for sugar content. This is because a daily limit has not been established, although there is good consensus on limiting the daily intake to less than 25% of total calories. As a result, it is very difficult for consumers to keep track of their daily sugar consumption. A while ago, I wrote about how to take the guesswork out of daily sugar to help set some boundaries and regulate the sugar intake.

Now, for the first time, the American Heart Association has come out with fairly clear guidelines on daily sugar which suggest that most women should limit it to less than 6 teaspoons and most men should limit it to 9 teaspoons. Note that these are still not official USDA recommendations, which I hope will follow soon. I think the breakfast cereal makers will respond first since their products tend to make heart-healthy claims although they contain a lot of sugar per serving. But I hope to see it change other food products as well. It is possible that this will drive the use of zero-calorie sweeteners in food products.

Ideas for packing a healthy lunch your kids will actually eat

My Twitter friend @RelevantMom alerted me to this article by the Associated Press which highlighted a few interesting school lunch box ideas from TV food stars Rachel Ray and Melissa d’Arabian. It is hard to resist the ready-to-go lunchables but they can end up costing a lot without providing good nutrition. Simple ideas like peanut butter, hummus, canned tuna, beans and lentils are good source of protein. You can mix them with breads, pitas and rice to create a quick and easy nutritious item. Add fruits and veggies selected by your child on the last grocery shopping trip to make sure he will actually have an interest in eating them. Get creative on snack ideas and skip the packaged snacks to save money. Their last tip is the best – add a loving note to the lunch box; it costs nothing but it can make your child feel special and loved when out of home in school where they might still not be very comfortable.

Share your tips for the school lunch box this back-to-school season. Here is what @themenumom suggested when I asked this question to my Twitter followers:

What has worked for you so far?

How normal is your eating?

Ever wonder if you practice normal eating? I can see you rolling your eyes and thinking “please, not another diet buzzword to make me feel guilty about my eating behavior”!

I was intrigued by a short note in the Well column of the New York Times by Tara Parker-Pope this week which asked this question. I am sure if you ask different people, they will come up with their own answer, and be quite sure that their eating preferences are perfectly normal. Turns out that the term normal eating was coined by famous dietitian Ellyn Satter. She explained that normal eating is when you “listen” to your body, eat when hungry and stop when full. Sounds simple and common sense. Except that we now seem to listen more to our tongue than to our stomach when it comes to eating. There are some who believe that the food industry has figured out how to rule the tongue by loads of salt, sugar, fat and other taste enhancing chemicals in processed foods. Self-control is lacking, especially when most family meals are consumed in front of the TV. We no longer have a sense of portion control. We try hard when we are motivated to go on a diet, only to give it all up and return to our old ways when things don’t work out the way expect. From this point of view, today’s normal eating is hardly normal the way nature intended it to be. I think it is about time we paid attention to it, especially when it comes to raising healthy children.

Functional food is nothing but dressed up junk food

That seems to be the opinion of many nutrition experts such as New York University’s Marion Nestle as cited by one of my favorite bloggers Dr. Ayala on her recent post “Are functional foods healthy foods?” I liked her article very much because she reminds us that with a little bit of right information, planning and effort you can prepare your own nutritious foods without having to waste money on these so called functional foods. It is easy to slap catchy slogans like low cholesterol, zero trans fats and fortified with brain-boosting omega-3′s without really changing the basic nature of the food inside the box. Sad truth is that such marketing works since such fortified functional foods deliver over $27 billion in sales each growing at up to 20% each year.

I am not personally against all processed foods. To our busy lives, they offer the convenience of immediate consumption although there is a cost to it. I do want to credit the food industry for many innovations that have made the modern life possible. I am not suggesting we turn the clock back by making all of our food from scratch. What I don’t like is that the industry at its heart is no longer concerned about the health of its consumers, rather the profit motive has become the main driver of innovation. Surely there are exceptions, which I hope will become the norm in future.

One Hungry Monkey and a dad committed to raising a healthy eater

I was finally able to finish reading a delightful book by Matthew Amster-Burton called Hungry Monkey! If you did not get a chance yet, check out my review of Hungry Monkey published this week. And let me know what you think.

Enjoy your weekend!

Photo source -sara.atkins on Flickr via everystockphoto
©2009 Littlestomaks.com

Happy Friday! Here are 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

Clues to the Mediterranean diet

It is now well accepted that the Mediterranean diet has good health benefits. But why it works so well and how important are the individual components in providing this health benefit has not been so clear. In a new study Anatomy of the health effects of Mediterranean diet, researchers have found that low to moderate consumption of alcohol, low consumption of meat and meat products, high consumption of vegetables, fruits, olive oil and legumes are the main factors which contribute to the healthfulness of this diet. It is tempting to break down a diet into its specific components to explain why it works or why it does not work. That is what Michael Pollan might call classic nutritionism - a tendency to break apart foods into components to explain effect on health. But, diet is only one of the factors for overall health and longevity – lifestyle and culture, as well as good healthcare are also critical. Still, I think that studies like these are useful, as long as we don’t lose sight of the big picture.

Now a sweetness enhancer rather than an artificial sweetener

Consumers want low or zero calorie sweeteners, no after-taste and naturally sourced ingredients in their food and beverages. That is why there is a lot of buzz about Stevia extract,which is being touted as the real, natural sweetener since it is produced from a plant. But it does give an after-taste, something the food companies are trying fix by adding taste masking ingredients in Stevia formulations. Taking a slightly different approach, Redpoint Bio – a company I wrote about recently in my article on salt reduction technologies – has now discovered a totally natrual sweetness enhancer RP44 that can work with almost any type of sugar. What it means is that this new ingredient can allow a dramatic reduction in the level of sugar needed in beverages or baked foods. They still have to get FDA approval, so it will be a while before it begins to appear in processed foods. I am not necessarily thrilled by this invention because it does nothing to reduce our reliance on processed foods. But it does show that specialty food additive industry is busy at work trying to help the food processing industry meet new customer expectations.

Food industry asks Obama to create a Presidential Commission for fighting obesity

In a letter to the President, several organizations, industry experts and academics are urging a creation of a Presidential Commission on Healthy Weights, Healthy Lives to combat the obesity epidemic. The idea is to coordinate the activities of the Department of Human Health and Services, USDA and other agencies involved in food and health policy. Sounds like they want more bureaucracy on top of an already monstrous bureaucracy – this is insane! I feel bad saying this because there are some very decent organizations behind this – the American Diabetes Association, American Public Health Association, Shape Up America, United Fresh Produce Association, Center for Science in the Public Interest (CSPI) and a few others. Food companies who are the purveyors of sugary-salty-fatty foods are notably missing from this list. I really don’t believe that more regulation will have that big an impact – I think policy should shift towards consumer awareness and incentives for prevention so that consumer demand forces food industry to innovate and move away from these unhealthy foods. It is beginning to happen, but not at the scale at which it can be sustained at the grassroots level.

Grocery stores going back to basics for recession-struck shoppers

The middle aisles, where you find canned veggies, fruits, cereals, pasta and sauces, is bringing the dough for grocery stores and supermarkets in the current recession according to this Wall Street Journal story. Private label and store brands are selling well and filling more shelves in these stores as consumers go for basic food staples for dining at home. I was amazed to learn that a store can make nearly 70% of its profits from these middle aisles! They are also providing more coupons for items in these shelves and bundling ingredients for home-cooked meals. Seems like low cost packaged food is winning the race in this recession and the fresh produce along the outside aisles is falling behind. Have you noticed a change in your grocery store? How has your shopping changed in the current environment?

Six ways to get your toddler to sit at the dinner table

Here are some great tips from Pediatrician Dr. Joanna Dolgoff to get your toddler to sit at the dinner table with you and not run around the whole house or in the restaurant! We struggle with this problem too since our twins are now out of their high chairs and insist on enjoying their new freedom while we try to eat dinner. My favorite tips from her article are – bring activities to the table (coloring, reading), and engage your child in a conversation. Check out her post and share your tips in the comments below.

Enjoy your weekend! And let me know what you think.

Photo source - Spiralz on Flickr
©2009 Littlestomaks.com

I have signed up for a 4-week nutrition and physical activity program at work! I am so excited about this program that I wanted to share it with you. It has been only a week, but I am already beginning to see a change in my daily diet and level of physical activity. So check it out, and if you want to give it a try, feel free to modify it to suit your needs.

The Program

• First, we had to select a team of 4 and register at our Fitness Center. You could do this as a family, or find a couple of friends to join you. Select an inspiring team name to make it real and interesting.
• Each team has an “empty” plate at the beginning of the week. After completing the activities assigned for the week, teams can earn “portions” to fill their plate. To get a “full” plate, each member of the team must complete these activities to a certain level.
• Teams earn raffle tickets based on how full their plates are at the end of each week. There is a bonus raffle ticket if a team earns all four full plates at the end of the program. After it is all over, they will be able to win “fun and exciting” prizes in a raffle.

The Activities

There are 6 “portions” on a plate with different goals/activities for the week:

1. Fruit – all 4 members must eat breakfast within 2h of waking at least 4 times per week
2. Meat/Bean – Complete a nutrition trivia worksheet each week
3. Grain – all 4 members must complete at least 30 minutes of exercise (or 10,000 steps) on 4 days of the week
4. Vegetable – at least 2 members must eat 7 or more servings of fruits and veggies 3 days of the week
5. Dairy – at least 2 members must eat 1 or more of the healthy food items marked with the Full Plate Club logo in the cafeteria
6. Oil – different activity for each week: complete health profile; take a group fitness class; find the nutrition fact sheet for at least 1 meal at your favorite restaurant; complete one of the 12 online program on stress management, nutrition or weight management

Why I am excited

The main reason I am excited is that I am now eating more fruits and vegetables each day! And I am realizing that it is quite hard to get 7 servings in a day – you really have to eat a fruit and/or vegetable at each meal.

Second, I am regularly eating salad with dinner, which I used to do in the past only occasionally. One trick we use is that we add some of our favorite fruits – strawberries, peaches, blueberries, mango slices, even pieces of cantaloupe or watermelon – in the salad. We also throw in almonds, sunflower seeds or walnuts! In short, everything goes, because that’s the way we can get it all in one meal.

Third, I can now mix walking with my workouts to complete the physical activity requirement. I usually go for a run or light strength building workout 3 times a week. But that is not enough since I am told we need to maintain a good level of physical activity at least 5 times a week. Now I can just go for a long walk on the days I can’t hit the gym and complete my 10,000 steps. I have also signed up for yoga once a week!

Why it works

I don’t think that winning a prize at the end of the 4 weeks is the driver for me. I think here are a few reasons it is working so well -

• Being in a team encourages you to complete your activities, after all you don’t want to “let your team down”
• The program is quite flexible and comprehensive
• It is only a 4 week program, not going to last forever
• It is educational – you need to look up nutrition information online to do those trivia worksheets
• It is fun to see your team’s plates “fill up” on the board
• It gives you something different to talk about with your friends and co-workers around the water cooler!

So wish me luck that I can stay with the program for 4 weeks and get used to the 7 servings of fruits and veggies a day!

This program is designed for adults, but I am sure you can tweak it to work with your young kids if you like. Share your ideas and opinion in comments below.

©2009 Littlestomaks.com