Getting enough vitamin A through diet (preferably) or supplements (carefully) is very important for growing children. In response to a reader comment to last week’s post 5 Things to Know About Vitamin A, I decided to write a follow up post on risks of vitamin A overdose and what you can do to protect yourself or your child.

Risks of vitamin A overdose

According to the 2nd edition of the PDR for Nutritional Supplements, overdose of vitamin A can be very serious in infants or children, and even adults:

• A single dose of 25000 IU per kilogram of body weight causes acute toxicity – vomiting, high pressure in the brain and death may occur (recommended daily dose for children less than 4 years old is 2500 IU)
• High amounts of vitamin A causes chronic toxicity – early signs are dry rough skin, cracked lips, sparse coarse hair and hair loss of the eyebrows. Late signs are irritability, headache, high level of liver enzyme in blood and liver disease.
• Supplemental daily doses of 10,000 IU or more taken by pregnant women have been reported to increase the risk of birth defects.
• Too much vitamin A can increase the risk of osteoporosis.

Clearly, you have to be careful not to exceed the recommended dosage and frequency if you are using a vitamin A supplement.

This is another reason why you should mainly rely on getting this nutrient from dietary sources such as carrots, sweet potato, cantaloupe, dairy products, eggs, green vegetables (spinach, collard greens), cod liver oil etc. Except cod liver oil, where it may be possible to get a lot of vitamin A at one time, all of these sources contain moderate amounts of provitamin A. There is no way you can get an overdose by consuming these sources.

Factors affecting vitamin A levels in the body

The amount of  vitamin A finally delivered into your body from provitamin A depends on the type of provitamin A (beta carotene, alpha carotene or beta-cryptoxanthin). Carrots, sweet potato, spinach and collard greens are good sources of beta-carotene, which is the more effective form of provitamin A. For example, 1 IU is equal to 0.6 micrograms of beta-carotene and 1.2 micrograms of other mixed provitamin A. Here is a nice table showing amount per serving of vitamin A from different foods. 5 servings of a variety of fruits and vegetables will provide about 3 – 6 mg of beta-carotene a day, enough for maintaining healthy levels of vitamin A in the long run.

Another factor affecting the vitamin A level is the amount absorbed in the small intestine after eating these foods. Efficiency of absorption can range from 9 – 22%. That is, out of the 3-6 mg daily beta-carotene, only about a tenth or a fifth will be absorbed. You can improve it by cooking the food and adding a little fat to the recipe. Absorption can be severely affected by certain medical conditions such as cystic fibrosis (pancreas), Whipple’s disease (small intestine), Crohn’s disease (intestines), ulcerative colitis (large intestine) and chronic liver disease.

Many processed  foods are fortified with vitamin A, that is they contain added vitamin A mostly in the form of retinyl palmitate and retinyl acetate. The efficiency of their absorption is much higher, typically around 60-90%.

A third factor that affects the amount of vitamin A levels is the amount stored in the body in the first place. Vitamin A is fat soluble and your body typically stores excess vitamin A in the liver. The half life of vitamin A is about six months, which means that it takes about 6 months for its level to fall down to half of the original levels. That is why it takes a long time of poor nutrition for vitamin A deficiency to show up.

5 actions you can take to be safe

Bottom line: vitamin A is vital for your child’s growth, but there are serious risks of accidental overdose or sustained high levels of vitamin A supplementation. Here are a few things you can do to be safe:

1. Rely on fruits, vegetables and dairy products to meet your growing child’s vitamin A needs. Check out these simple vitamin A rich recipes.
2. Reduce or limit processed foods, they are artificially fortified with vitamins (including vitamin A). While one serving of a particular food item may not have a lot of vitamin A, when you add all the processed food together, you can end up consuming a lot of them.
3. Check the nutrition facts label on your child’s multivitamin if you are using one. Vitamin gummy bears are very popular!
4. Talk to you doctor about a suitable vitamin A supplement if your child has a medical condition. Do not make this decision yourself and do not pick up any random over the counter supplement yourself.
5. Get an annual eye exam for both you and your child to catch early eye health problems

Are you using a vitamin supplement for your child? Have you checked the label? Share your thoughts and concerns in a comment below.

©2010 Littlestomaks.com

Earlier this week I wrote about 5 Things You Need to Know About Vitamin A. This is a very important vitamin especially for growing children. It is required for their eye health, immune system, healthy skin, bone development, brain development and development for blood cells. A severe deficiency is known to cause night blindness.

As a follow up, I decided to scan a few of my favorite recipe sites for kid-friendly and easy-to-make recipes rich in Vitamin A. Check them out and be sure to visit these blogs for more great recipes.

Sweet Potato and Butternut Squash Bisque on Chow and Chatter

This recipe has a tripe-dose of vitamin A rich vegetables – sweet potato, carrots and butternut squash! Strictly speaking, bisque is a thick soup, but this recipe could easily be turned into rich, creamy dip for french bread or baked chips. I would skip the wine, of course, when offering it to your kids! Check it out.

Sweet Potato Quesadilla on Fix Me A Snack

This is such a cool idea for a quick snack rich in vitamin A! It uses sweet potato, applesauce and optionally cranberry sauce and of course cheese and tortillas. Our twins love crunchy quesadillas, so we are definitely going to give it a try!

Chili Mac ‘N Cheese with a Healthy Makeover on Meal Makeover Moms

Kids love Mac ‘n Cheese, but the problem is the fat and refined carbs from the usual ingredients – pasta, milk and cheese. The Meal Makover Moms did  a simple and clever ingredient swap to make this a healthier option. Vitamin A comes from the milk, cheese and the vegetarian chili.

Börek – Spinach Pastry on Binnur’s Turkish Cookbook

This is our family favorite! Spinach filling and a liquid mix made up of milk, egg and olive oil are added between layers of phyllo pastry and the whole stack is baked in the oven for a crunchy, yet soft spinach pastry. It is a great snack or an appetizer before a meal.

Butternut Squash Soup on Littlestomaks

We have made this recipe several times now and it has become one of our favorites. It takes a little longer to cook, but it is very good! The good thing is that you can make enough to last for a couple of days. Butternut squash is a great source of vitamin A and other vitamins.

Enjoy these recipes and let me know what you think!

©2010 Littlestomaks.com

There is a reason why you might remember grandma’s eat your carrots advice! Vitamin A is really a very important vitamin for both you and your child. There is more to vitamin A than carrots though! That is why I thought of researching this topic  from a variety of sources and writing about it in a simple Q&A format. Let me know how you like it! Feel free to share your ideas, opinions and unique insight on this subject.

What is vitamin A?

Vitamin A is a general name for a class of nutrients which are important for our health, particularly eye health. Chemically, they are related to a substance called retinol. Most vitamin A supplements are formulated to have a certain form of retinol, for example retinyl palmitate or retinyl acetate. These compounds are soluble in fat. They are stored in the liver when taken from diet or supplements.

You might have heard that carrots are a good source of vitamin A. Well, that is only partly true. Carrots in fact contain a compound called beta-carotene, which is what gives the orange color. Beta-carotene is not vitamin A, but a provitamin A; that is, it is converted to vitamin A when it is absorbed in our intestines.

Why does my child need it?

Vitamin A is very important for a growing child. According to the 2nd edition of the PDR for Nutritional Supplements, vitamin A is critical for healthy vision and its deficiency is known to cause night blindness. It is also important for healthy skin, bone development, brain development and development of blood cells. It also supports proper functioning of our immune system.

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

In general, the daily recommended amount of vitamin A is 5000 IU (IU means International Units). For infants, however, the FDA has recommended a daily amount of 1500 IU. And for toddlers less than 4 years old, the recommendation is 2500 IU.

Since breastmilk is one of the best sources of vitamin A, the FDA recommends a daily amount of 8000 IU for pregnant and nursing women.

Now, if you are using a supplement, it is easy to keep track of the IU’s. But what if you are relying on fruits, veggies and other dietary sources of vitamin A? Here are a few guidelines for you (ref: Wikipedia.org):

1. One serving of milk (1 cup) typically has 10% of the recommended daily amount (RDA)
2. 1 hard-boiled egg (yolk) has about 10% of the RDA
3. 100 g of raw carrots will provide close to 100% of the RDA
4. 100 g of sweet potato will deliver about 80% of the RDA
5. 100 g of spinach has about 50%, collard greens about 40%, kale about 80%, pumpkin about 40% of the RDA
6. Cantaloupe, apricot, papaya, mango etc have lower amounts, but they are a good, diverse source of vitamins and minerals
7. Liver (beef, pork, turkey, chicken, fish) is a very rich source of vitamin A; 100 g provides over 700% of the RDA!

If you are using a supplement, be careful not to exceed the recommended dose and frequency. Also, select a brand known for using high purity ingredients. Check out my review of some of the popular kids brands of multivitamins.

What happens if my child does not get enough vitamin A?

When vitamin A rich foods are missing from your child’s diet over a long period of time, and you are not using any supplements, there is a possibility that your child may develop vitamin A deficiency. In case of certain medical conditions such as cystic fibrosis, Whipple’s disease, Crohn’s disease, ulcerative colitis, pancreatic disease and liver disease, there may be a problem with absorption of not only vitamin A from food but also other essential nutrients. Chances are, you are already consulting with a doctor if you are in this situation. If not, you should talk to your doctor about it as soon as possible.

In the rare case (at least in the developed countries), if your child does not get enough vitamin A and develops a deficiency, it can lead to dry eye and vision problems including night blindness. The range of vision problems associated with vitamin A deficiency is called xerophthalmia (xeros means dryness, ophthalmia means of the eye). It can make your child more prone to infections and compromise his immune system. Under extreme conditions, it can also slow down the child’s growth.

Should I be concerned about vitamin A deficiency?
Since vitamin A is stored in the liver, you do not need to worry about it on a day-to-day basis as long as your child is getting a balanced diet on average which includes a nice blend of fruits, veggies, dairy and meat products. In most of the developed countries, vitamin A deficiency is not a problem.

Having said that, clinical vitamin A deficiency (VAD) is a big problem in poor countries of Africa and Asia according to this World Health Organization (WHO) report. Unicef’s childinfo.org has a nice summary of the global vitamin A deficiency problem, especially among children, which indicates that over 5 million children of pre-school age could have clinical VAD. And as many as 190 million pre-school age children and 19 million pregnant or nursing women do not have enough vitamin A in their daily diet, which puts them at a very high risk of VAD. This should be troubling to us even though it may not affect us directly in the developed world.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough vitamin A? Do you have recipes that use vitamin A rich ingredients? 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 Victoria Retelny explains why omega-3 is important for growing children and suggests a few food sources of these essential fatty acids.

Question: Is Omega 3 proven to be helpful for children? Can you recommend a few good sources and brands of Omega 3?

Answer:

Yes, omega-3 fatty acids, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are found in breast milk, are beneficial for children’s normal growth and development.  For infants, DHA has been found to be vital for visual and brain function and development.  Some research has shown these essential fats to help children with attention deficit & hyperactivity disorder (ADHD). As children grow into adults, there is evidence that omega-3s are a great way to keep the heart healthy, too.

As always, food sources should be the first choice for your child’s diet.  Omega-3 fatty acids come from two sources: plant foods like walnuts, flaxseeds, tofu, soybeans, and canola oil, which contain alpha-linolenic acid (ALA) and fatty fish, which contain both DHA and EPA.  Some of the best fish sources of omega-3s are salmon, albacore tuna, lake trout, mackerel, and herring.  Since some fish can be high in mercury and other contaminants, there are limits to how much children (and adults) should eat.  According to the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency, up to two average fish meals or 12 oz per week – is safe for children.  Since albacore tuna is higher in mercury than chunk light tuna, limit the serving to 6 oz. per week.

The types of fish that children (and adults) should avoid due to high mercury levels:

• Shark
• Swordfish
• King mackerel
• Tilefish (Golden bass)

The Dietary Guidelines for Americans 2005, advise people to check local advisories to learn about the safety of fish caught in nearby local lakes, rivers, and coastal areas. Advisories may recommend that people limit or avoid eating some types of fish caught in certain places. If no advice is available, young children may eat up to 1 meal per week of fish from local waters, but no other fish during that week.

The U.S. dietary supplement market is exploding with omega-3 capsules. Use caution, particularly with young children, when giving supplements – of any type.  Dietary supplements are not regulated by the federal government.  According to the FDA’s Web site, supplements ingredients may be reviewed for safety, but not effectiveness.  The ultimate responsibility for product safety is on the manufacturers and distributors before the supplements reach store shelves. The FDA will step in if products are found to be unsafe or if they contain false or misleading claims.

So what are good sources of omega-3s for children?  The best sources are fish and “designer” foods like omega-3 fortified cereal, yogurt and eggs.  Although, a recent article in Journal of the American Dietetic Association states that there is no specific recommendation for EPA and DHA individually right now, the need to get a balanced diet that includes essential fatty acids like omega-3s is important, particularly for growing children.  As always, consult a physician before giving fish oil capsules to children under 18 years old.

References:
Kris-Etherton P, Hill AM.  n-3 fatty acids: food or supplements?  J Am Diet Assoc (2008):108(7);1125-1130.

US Food and Drug Administration, Dietary Supplements: What You Need to Know.

Omega-3 fatty acids, fish oil, alpha-linolenic.  The National Institutes of Health, Medline Plus.

Dietary Guidelines for Americans. MyPyramid for Preschoolers.

©2009 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.

Happy Friday! Check out these interesting nutrition related articles and drop a comment if you would like to share an opinion.

Carrots are boring but what about X-ray vision carrots?

It appears that giving veggies interesting and creative names might work if you would like your kids to try them more. In a recent study, 4-year old preschoolers ate twice as many carrots when they were presented as “x-ray vision carrots” compared to just “carrots”. That is amazing! I guess it might work with fruits too although they were not included in this study. Creating an experience of fun with veggies worked for @MommyMellie, who wrote in her guest post on this blog about how carrots, broccoli  and finger paint got her child to tolerate veggies and even like them. So, let your imagination go wild and have fun with fruits and veggies. Here are some more tips on helping your kids eat more of them.

“Organic” stamp does not mean food safety

Remember the recent outbreak of salmonella from the peanut plants in Texas and Georgia? Turns out, they also had the “organic” certification from the USDA according to this article in the New York Times! This is a good time to remind ourselves that organic certification does not imply food safety, even though you may expect it because you pay top dollar for these foods. Just like every other government program, the process of getting and maintaining the organic certification has become a beuareucratic mess. It took the private certifier for the Peanut Corporation of America nearly 7 months to report the problem to the USDA. By then, several people had been infected and many foods were on the recall list. In my opinion, these inspectors should also lose their license!

Does it mean you should give up on buying organic? Certainly not. However, it is probably a good idea to understand what the label means and not make any assumptions.

Getting a blood test for food allergy? Watch out for misdiagnosis

Seems like a lot of people are getting a blood test for detecting food allergies in their children. And in a lot of cases, kids and adults alike are getting diagnosed with allergies they don’t really have. In one case according to this article, a young boy was put on feeding tube because blood tests indicated he was allergic to everything! After doing a food challenge, doctors were able to introduce 20 foods into his diet. This is an extreme example for sure, however there is an increase in the number of misdiagnosed food allergies when blood tests are used. A 2003 report in Pediatrics reported that positive result on a blood allergy test correlated with less than 50% of real food allergy. If the blood tests show a huge positive allergy response, it is best to contact a specialist. Introduce new foods slowly and watch of any allergic reactions.

Do you have any experiences with food allergies in your kids?

Open your eyes to healthy eating habits

March is “Save Your Vision” month sponsored by the American Optometric Association (AOA). Most people already know that carrots are good for eyes because they supply the beta-carotene needed for night vision. There are several other key nutrient for long term eye health which are not that commonly known. Accordinng to AOA’s  Diet and Nutrtion website, researchers have now linked nutrients such as lutein, zeaxanthin, vitamin C, vitamin E, essential fatty acids and zinc to reducing several eye diseases. Foods such as spinach, kale, citrus fruits, nuts, whole grains, fish and supplements can provide all of these nutrients. This is a good reminder to try various foods with your toddler so he can get a balanced diet. Most toddlers are picky eaters, so you can also consider a daily multivitamin supplement.

Enjoy lentil soup

Our twins have now developed a taste for lentil soup. Check out our simple lentil soup recipe! Hope your toddlers find it as appealing as ours.

Enjoy your weekend!

Image source: orangeacid on Flickr
©2009 Littlestomaks.com