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.

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

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

Greetings! Hope you all are enjoying the beautiful days of Fall. I simply love this time of the year. We are getting ready for Trick-or-treat and pumpkin painting, and the twins are excited! They are already dreaming of collecting candy – it is going to be an uphill battle trying to keep them from eating too much. I won’t spoil the fun by telling you their costumes this year yet, but will surely post a photo after Halloween.

Here are the 5 nutrition related news that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

A new index to help you select affordable nutritious foods

A new food rating system called the Affordable Nutrition Index (ANI) was introduced this week at the American Dietetic Association’s Food and Nutrition Expo in Denver. The idea is to provide a score that takes into account the cost of a certain food item in addition to its nutrition value. A food item with a high score means that it is high in 9 nutrients (protein, fiber, vitamin A, C, E, calcium, iron, potassium and magnesium), low in 3 nutrients (saturated fat, added sugar and sodium) and costs less on a per serving basis. Sweet potato, broccoli, green pepper, orange and banana scored high on the index (over 100) while packaged convenience foods scored lower than 100.

This index has been developed by Dr Adam Drewnowski, Director of the Center for Public Health Nutrition at University of Washington in Seattle. He used the Nutrient Rich Food Index (NFR9.3) which he previously developed and a price per serving information from food prices database, Seattle area supermarkets and industry sources. This research was sponsored by the Campbell Soup Company. Not surprisingly perhaps, many of the condensed soups from Campbell ended up with a high score around 100 compared to many fresh or cooked vegetables and even fresh fruits.

I am intrigued by this idea since we all want to select foods that have high nutritional value at an affordable cost. However, I don’t think that this is the only way to make that choice. I was disappointed to see that vitamin D was not included in the 9 nutrients to promote in the NFR9.3. Plus cost per serving is probably not the right measure of what a customer pays when buying a product. Also, you can manage cost by buying seasonal fruits and vegetables from local sources. Still, I think it is a good idea and I plan to write more about it in future.

Coke’s response to the debate on obesity is lame

Coca-Cola, the icon of sugary drinks is under attack! CEO Muhtar Kent wrote an Op-Ed piece in the Wall Street Journal on October 7th defending his company against proposals of soda tax. Coke Didn’t Make America Fat is what he believes; and quite arrogantly he points the finger to his own customers saying they lead a sedentary lifestyle! Well, Coke did make America fat according to my blogger colleague Dr. Ayala who wrote an excellent piece this week in response to Mr. Kent’s lame arguments.

So far, Coke’s response to the current debate on the role of sugary drinks in our obesity problem is rather lame in my opinion. They have announced that they will add calorie information on the front of Coke cans. They have given a large amount of money to the American Academy of Family Physicians (AAFP) to develop consumer education content as part of their Consumer Alliance Program. They are also a part of the Healthy Weight Commitment Foundation (HWCF), a group of 40 organizations seemingly engaged in a collaborative effort to address obesity. And now in their latest move, Coke has announced that they will introduce a 90-calorie mini soda can so that people can limit their intake of sugary cola.

While I am no fan of the twinkie tax, I do not believe that these actions by one of America’s top brands are of the high caliber needed to solve one of America’s most challenging health problems. Coke needs to do more than just pay lip service and make lame arguments defending their products in public. They need to take a more grass-roots approach – building playgrounds in schools, sponsoring healthy lifestyle events, developing after-school programs, integrating nutrition and physical education, sponsor healthy nutritious school lunches just to name a few examples. They need to measure the effectiveness of these programs in reducing obesity and make the data public.

Coke’ 3Q financial results show that they generated $6.3 billion in cash from operations year-to-date in 2009. They spent $241 million buying back their own shares. A little more of that cash spent on real programs to solve our obesity problem will not make a dent in their profits! What do you have to say about that Mr Kent?

FDA puts the hammer down on front-of-box labeling

The Smart Choice program it seems was the last straw according to Marion Nestle who writes a blog called Food Politics! In a letter to the food industry, the FDA is openly questioning the arbitrary nutrition standards used by companies to develop these labels which end up showing their own products as healthy. FDA wants to develop a set of independent criteria which these labels will need to meet before companies can use them on their products. FDA also wants to understand how these front of the box labels affect consumer choice.

I say, it’s about time. The Nutritional Facts panel, usually at the back or the side of the box, is too complicated for most consumers to read and understand. Consumers are looking for something simple that allows them to quickly make a decision.

We are lagging behind other countries in this area. A traffic light based food labeling system developed by the industry based on government guidelines in UK seems to be working very well. Why can’t we do the same here?

Here is a good background information on different types of front of box labeling systems. What is your opinion? Have you come across a labeling system you really like?

Toddler diets a cause for concern according to the 2008 FITS data

Latest data from the 2008 Nestle Feeding Infants and Toddlers Study (FITS) confirms the sorry state of a typical toddler diet in America. Most toddlers and preschoolers are not eating fruits and vegetables. They are consuming too much saturated fat and sodium. French fries are the most popular vegetable!

Good news is that the diets of infants and older babies are much better compared to the 2002 data. Mothers are breastfeeding their children longer and consumption of sugary drinks is decreasing. There is a risk of iron deficiency in some children.

Looks like parents and caregivers are following the feeding guidelines for infants. So why do things go south during the toddler years? Is it because of picky behavior? Or is it because toddlers eat what their parents eat? Or a combination of the two?

Not much progress has been made in the diet of toddlers since 2002. We need to make a deliberate effort to improve this situation.  Having dinner together, being a role model and encouraging fruits and vegetables is critical to solving the problem of childhood obesity. And in case you are struggling, here are some tips for picky eating.

Let us bring the school nutrition standards to the 21^st century

Can you believe that it was 1995 when the standards for the National School Lunch Program (NSLP) and School Breakfast Program (SBP) were last revised? Yet the NSLP served lunch to over 30 million children and SBP served breakfast to over 10 million children in 2008! If we are serious about fighting the battle of childhood obesity, we need to revise these standards and bring them to the 21st century!

Well, the good news is that the Institute of Medicine (IOM) has now issued its recommendations in a report titled School Meals: Building Blocks for Healthy Children, which the US Department is going to consider as they revise these standards. Recommended meal requirements encourage more fruits & vegetables, whole grains, min and max levels of calories and limit saturated fats  and sodium.

This is good news! I hope they will begin to implement these recommendations by the time our twins start going to school. I think progress may be slow due to cost and bureaucracy, but at least it’s a good start.

Enjoy and do let me know you think. I would love to have you share your best tips in comments below.

Photo source -cambodia4kidsorg on Flickr via everystockphoto

©2009 Littlestomaks.com

Greetings!This week is the World Breastfeeding Week. Organized by the World Alliance for Breastfeeding Action (WABA), the focus this year is In Emergencies, Breastfeeding is a Lifeline. I never thought about breastfeeding this way, but it makes sense. Children and infants are most vulnerable during a catastrophic emergency – whether natural or man-made. According to WABA estimates, child mortality can be 2 to 70 times higher than normal under these conditions due to diarrhea, malnutrition and respiratory illness. They believe that by supporting breastfeeding in non-emergency situations, we can be better prepared to save the lives of young children during emergencies. Here is a great post by my blogger friend Annie on this subject by Annie on PhdInParenting.

Here again 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.

Millions of kids vitamin D deficient – here we go again!

It seems like our appetite for reporting vitamin D deficiency in kids is insatiable! In yet another study published recently in Pediatrics, researchers report an alarming prevalence of vitamin D deficiency in kids 1-21 years old. They find that 9% (about 7.6 million) children are deficient and 61% (about 50.8 million) have insufficient levels of 25-hydroxyvitamin D. This news got a lot of coverage this week, mainly because the numbers seem so high. Also, in the same article, these researchers highlight a link between low levels of vitamin D and increased risk of cardiovascular disease. This sounds really scary, and no doubt, makes a perfect headline for an attention-grabbing story.

I have a few problems with these types of studies. First, they rely mainly on the level of 25-hydroxyvitamin D in blood. There is no consensus among experts when it comes to estimating deficiency or insufficiency in children. Second, the biochemistry and processing of vitamin D is very complex, something I don’t claim to understand at all. But I am certain of this – it cannot be as simple as just the blood level of 25-hydroxyvitamin D which relates to cardiovascular health or bone density. But the real reason why I get frustrated is that these studies do not answer the “so what?” question a parent might be concerned about. Drink milk and vitamin D fortified OJ, let your kids out to play, not watch too much TV – well, that is old advice and should be followed with our without such sensational news.  Should you ask your pediatrician for a 25-hydroxyvitamin D test? Should you take supplements? There is no real, practical and actionable advice from these “experts”.

My 2 cents – when you hear this type of news, take a deep breath and don’t panic. Take a quick look at what your child is getting on average – milk, OJ, cereals, fish, eggs, cod liver oil etc. How much outdoor activity in the sun he gets on average. Take a long term view on this but continue to watch the diet and activity level regularly. If you still have doubts, ask your pediatrician if a supplement is needed.

No one wants to hang out with overweight kids

Why are overweight kids so picked on? A very interesting post from Dr Joanna Dolgoff – one of our Ask the Expert contributors – provides some insight. Appears that kids have more sympathy for children with handicaps, and would rather be friends with them, than hang out with overweight or aggressive kids. Deep down, overweight kids are blamed for their condition. They should be able to change it by losing weight is a common belief. I wrote about this in my post on childhood obesity because this kind of negativity leads to low self-esteem and a downward spiral of physical and emotional health problems among overweight and obese kids. Stereotypes about obesity form early in life it seems.

FDA and USDA get a budget of $125 billion

That is a giant number! Extra funding is supposed to go for improving food safety and farm subsidies. What surprised me though is the estimate that almost half of the budget for the two agencies is set aside for food stamps and Government nutrition programs. What kind of a return on investment can we expect from this level of spending? I find it ironical that on one hand we spend extra on healthcare in managing obesity-related diseases, while on the other, we have to also budget a huge amount fighting hunger and poverty. These two problems are two sides of the same coin in my opinion, but I do not yet see a comprehensive policy (and budget) to address them. We know that there is poor communication and cooperation between different Government agencies – the right hand does not know what the left is doing, but both want to get bigger and fatter and demand more funding! And as far as food safety is concerned, the approach is to focus on compliance rather than prevention. This smells of more bureaucracy to me!

So many cooking shows, so little cooking

Michale Pollan wrote a very good – although very long – article in the New York Times magazine this week. Out of the Kitchen, Onto the Couch takes us through the history of cooking shows starting with Julia Child to the likes of present day Iron Chef and Rachel Ray. We watch the Prime Time food network for entertainment value these days, not to learn anything about cooking the food ourselves! Pollan makes two great points – one, that the food industry along with the Television has been quite successful in taking over the “cooking” part from us by providing us with relatively cheap, readily available, packaged nutrition (poor nutrition I must admit). And second, that we are now quite comfortable ordering fancy items at restaurants and our appetite and desire for an ever increasing array of foods seem never ending. The less we cook, the more we eat and the more weight we put on. So how can we get back to cooking? We don’t have time for cooking, but we have time to watch a cooking show. Seems to me it is a matter of priority and attitude. I think we need to invoke Nike’s Just Do It! for preparing our own food. Not necessarily from scratch, as a lot of purists might want you to, but enough so that you can control what goes inside your body.

Check out this cookbook review and giveaway

Here is a shout out for my blogger friend Jenna of Kidappeal. She has done a great review of Vegetables Get the Royal Treatment by Jill Nussinow (aka The Veggie Queen!), and she is giving away a copy of this book to one lucky winner selected from the comments on the post. It is very simple to enter – all you need to do is to leave a comment about your favorite vegetable and your favorite ways to prepare and eat it. Check it out, the contest ends on August 16th.

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

Photo source -Raphael Goetter on Flickr via everystockphoto
©2009 Littlestomaks.com

Happy Friday! This photo touched my heart and reminded me the value of nutrition and care for our growing children. Sometimes, a picture really is worth a thousand words!

That said, here are the 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.

Eco-Atkins diet

A low carbohydrate, high protein Atkins diet is popular for weight loss, but carries the risk of increasing LDL (“bad”) cholesterol. Now some researchers are suggesting that a vegan diet rich in protein from plants and nuts reduces weight and lowers cholesterol, by as much as 20%. In a study published in the Archives of Internal Medicine, they concluded that a  plant-based low carbohydrate “eco-Atkins” diet resulted in about the same weight loss as a high-carbohydrate, dairy and whole grain vegetarian diet, but reduced the LDL cholesterol by a larger amount. Although the size of the study was small, it proves again the many benefits of a plant-based diet. Cutting down on meats which are rich in saturated fats and cholesterol is a good idea even though the specific results cited by this study may not be seen for everybody.

New FDA chief focuses on food safety

In an interview with the Associated Press, the newly confirmed FDA chief Dr. Margaret Hamburg put a high priority on restoring FDA’s credibility by using science-based information to drive decisions, and by implementing risk-based controls for early detection of food contamination in the farm-to-store supply chain. I don’t think there is anything earth-shattering here; this is precisely what the FDA is expected to do anyway. Also, this is what the public wants to hear in light of the peanut, pistachio, spinach, lettuce and tomato outbreaks. The public confidence in the nation’s food supply is shaken up, so naturally this is high on FDA’s agenda. What I would like to know is how she plans to fix the management system, improve visibility of problems and bring in a sense of accountability in the public office. Till then, these are simply nice sounding words and we will continue to remain one more outbreak away from another massive recall and public health scare.

Consumers want healthy food but unwilling or unable to pay more

According to the United Soybean Board’s 16th Annual Consumer Attitudes About Nutrition report, nearly 9 out of 10 consumers report wanting to buy nutritious and healthy food but only about half are willing to pay more. Of the remaining, about half say they want to but can’t afford nutritious food right now. A fairly large number of them also say that the food they buy is already healthy, and that the healthier version would not taste as good. There is a certain bias in this survey towards processed foods since that is clearly of interest to the soy industry. I don’t think they even considered asking questions about fresh vegetables and fruits and cutting down on meats. My guess is that the definition of healthfulness was limited to the nutrition facts label – the usual calories, fats, carbohydrates, sugars, proteins, vitamins and minerals etc. And the interesting fact about these labels is that even though most people do review them before buying, about half find the nutritional information confusing. With a limited definition of “healthfulness” and confusing nutritional information, how can we expect consumers to make the right trade-offs between buying healthy food and cost?

Challenges of reducing sugar in (processed) foods

I certainly cannot relate to the “challenges” faced by the food technologists in formulating foods with artificial sweeteners. Nor do I want to! But I found this podcast interview with the manager of sweetener technology at Tate & Lyle posted on the FoodNavigator site quite interesting. Turns out that sugar not only provides sweetness, it also affects the texture and feeling of the food. That is why, a simple substitution of natural sugar with artificial sweetener doesn’t work so well except in beverages. In ice cream, for example, reducing sugar or adding artificial sweetener can change its freezing point, and as a result, the consistency. In baked goods, sugar affects the color, taste, bulk and shelf life, which makes it difficult to reproduce with artificial sweeteners. So I guess they make these food technologists earn their paycheck after all! Anyway, this manager also commented that consumers want taste and choice, and for those wanting healthy foods with low sugar, it is a challenge to offer them all three. Tells me that her interpretation of what consumers want is incredibly – though understandably – quite narrow. What happened to fresh, natural, locally sourced, green, organic and wholesome? Guess they have decided not to listen to those customers since they will probably not be helping Tate & Lyle’s bottom line anyway!

Simplicity is the new message for “affordable” healthy food

My blogger friend and registered dietitian Janet Helm was recently interviewed by ABC News (Go Janet!) on the recent trend of going “back to basics” when it comes to food advertising. Janet has written about these trends on her blog Nutrition Unplugged in a couple of very interesting articles. So check out her blog and the ABC interview via her post Simplicity Sells in Tough Economic Times. Janet is also a contributor to my Ask the Expert where she recently wrote a very informative post about sushi and toddlers.

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

Photo source – Thiru Murugan on Flickr
©2009 Littlestomaks.com

Here is a selection of noteworthy news related to child nutrition. Most of the commentary is mine. I have provided a link for each if you want to read the full story.

It is amazing, and quite encouraging to hear a school Principal say “Childhood obesity, it’s our tsunami, it’s our Katrina”. These are the words of Dr. Yvonne Sanders-Butler of Browns Mill Elementary School in Lithonia, Georgia, which decided to go “sugar free” 10 years ago.

There are no bake sales here, no birthday cupcakes, no cookies or ice cream!

What is even more amazing is what Dr. Yvonne says about the achievements of the school as a result of this policy. In the first six months of the sugar ban, disciplinary incidents went down 23 percent, counseling referrals decreased 30 percent, and in the first years of standardized test scores, reading scores improved 15 percent! Browns Mill was named a national blue ribbon school and a Georgia school of excellence in 2005.

Read the full story here. Also check out the Achieving Academic Excellence Through Nutrition And Exercise page of the school.

News of infant formula made with melamine contaminated milk in China broke in September 2008. In China alone, 4 children died and 53,000 got sick as a result of this reckless act. According to health experts, ingesting melamine causes kidney stones, urinary tract ulcers, and eye and skin irritation. It also robs infants of much-needed nutrition.

Several countries in Asia, Africa and Europe banned products made from Chinese sourced milk. Later in the year, the European Union (EU) banned all baby foods made with Chinese milk.

However, more relevant for the US consumers is this follow-up announcement from the FDA’s director Stephen Sundolf:

“Amounts of the industrial chemical melamine or the melamine-like compound called cyanuric acid that are below 1.0 ppm [1,000 parts per billion] do not raise public health concerns”

Although, 1.0 ppm may appear to be a very small amount, a key question, however, still remains unanswered. Why should there be any trace of this “industrial” chemical melamine in infant formula in the first place? Melamine is a synthetic chemical used in making hard plastic materials, however it can also be produced inside the body from an insecticide called  Cyromazine. It is possible that these chemicals are transferred at ppm levels from food packaging, labeling and raw materials in the food supply. In addition to establishing a “safe” limit, there should be an attempt to remove these chemicals entirely from the supply-chain during production of infant/baby food products.

Read the full story here.

The U.S. Department of Agriculture’s annual report on food security showed that 691,000 children lived in homes where families had to eat non-balanced meals and low-cost food, or even skip meals because of a lack of money. Now this is personally troubling to me! How can it be that on one hand we have an overabundance of food, and a rapidly growing problem of childhood obesity, while at the same time, there are so many children who are growing up hungry. Quite clearly a paradox.

In her recent post Addressing Hunger and Obesity with “Change” Policy, my blogger friend Rebecca Scritchfield is hopeful that Tom Vilsack, when confirmed as President Obama’s Agriculture Secretary, will follow up on his pledge to put “nutrition at the center of all food assistance programs”. Clearly, there is a need for creative ideas to solve this problem. It should be embarrassing to see a child go hungry in America.

Read the full story here.

I found this correlation quite surprising. Dr. Graham MacGregor of St. George’s Hospital Medical School, London, England, who authored a study published in Hypertension: Journal of the American Heart Association in February 2008 told this to CNN:

“Salt is playing a hidden role in the obesity epidemic by causing more intake of sugary soft drinks. Children get habituated to a salty taste. Much of the obesity epidemic is in the hands of the food industry. The most important thing possible is to cook fresh food as much as possible — those meals will have very little salt at all. Virtually no products use salt as a preservative anymore. Choose bread with less salt, choose cereals with less added salt. Try to avoid these very salty ready-made foods.”

Read the full story here.

Consider this – 44 major food and beverage marketers spent $1.6 billion to promote their products to children under 12 and adolescents ages 12 to 17 in the United States in 2006. It is likely that a similar amount was spent in 2007 and 2008. Further, this marketing is “integrated”, that is, it combines the old (TV, print) with the new (internet, sweepstakes, in-store promotion) media.

In analyzing the data, the report calls for all food companies “to adopt and adhere to meaningful, nutrition-based standards for marketing their products to children under 12.” The need for such an advice proves that there is room for improvement in both the message and the products which are targeted for this age group.

Read the full report here.

A report from the American Academy of Pediatrics reccomends that overweight children (BMI between 85th and 95th percentile) and obese children (BMI > 95th percentile) be screened for fasting lipid profile regardless of family history of hyhpertension or other risk factors. Amazingly, it is recommended that such screening should take place after 2 years of age but no later than 10 years of age. For children over 8 years old, and with high LDL (bad cholesterol), cholesterol lowering drugs may be prescribed.

This is quite a radical recommendation which recognizes the rising epidemic of childhood obesity and its consequences on heart disease and other health conditions.

Read the full story here.

Here are a few other noteworthy stories suggested by my Twitter friends:

• @Andamom found the Blue Zones on Oprah Winfrey’s show very interesting where Dr. Mehmet Oz “goes deep inside these blue zones where people live longer than anyone else”. What is their secret? The four “hot spots” featured in the show were Costa Rica’s Nicoya Peninsula; Sardinia, a Mediterranean island 120 miles off the coast of Italy; Loma Linda, California’ and Okinawa, Japan. In all cases, a lifestyle based on eating natural, un-processed foods, lots of hard work and connection with commiunity were the key ingredients to a long, disease-free life.
• @ayalalaufer referred to the work of Professor Charlene Elliott from the University of Calgary, Canada, in her post Fun food:” Is it nutritious? Is it even fun? to show how mixed messages are sent to kids about “nutrition” and “fun” when food products are advertised. Is it misrepresentation? Maybe, but seems like it is still all within the rules. I was amazed to read that “among the 326 fun foods that were of poor nutritional quality, 202 (62%) had nutritional claims”. She rightly suggests that there is no need for kids to have their own special food. Parents should encourage their children to eat what they themselves eat at each meal.
• In Can you really pressure kids to eat healthy? @ayalalaufer links to a study in the scientific journal Appetite which concludes that if you simply cannot build long-term healthy eating habits in your kids if you force or coerce them into eating healthy foods. This is consistent with what Dr. Spock says “children need to want to eat healthy foods”. If you try to force them too much, they will reject it and develop a life-aversion to it even if you think it is good for them.
• In her post Infant feeding choices and obesity, @phdinparenting links to a very interesting report which found that rats that consumed junk food during pregnancy and while breastfeeding had offspring that preferred junk food too. She cautions against switching to formula just because a breastfeeding Mom cannot give up her favorite snack and suggests that breastfeeding itself builds self-regulation in the baby and protects against overeating and obesity later on. It is important to draw a distinction between a pattern of frequent junk food consumption and occasional treat of a favorite snack.

Do you have a nutrition story from 2008 that caught your attention? Feel free to share in the comments section.

Imagine driving through a busy intersection that has no traffic lights. Instead there are boards showing the driving rules in large print that you must read and quickly understand so you can pass through safely. And to make things worse, every intersection has different rules even though the boards look pretty much the same from a distance. It would be a disaster!

I think this is exactly the case with food labels. They all look the same but they pack a lot of information that you are supposed to digest (pun intended!) so you can make a healthy choice. And remember, all the bad stuff is usually hidden in the fine print on the label! Let us say your grocery cart on your weekly shopping trip has about 50 different items. Even if you spend just 1 minute trying to figure out the food label, it would take you almost an hour just to read and understand the information. Add to that all the walking through the aisles you need to do to get everything on your list, and you can be sure to spend your entire Saturday afternoon in the store. And if you have a screaming toddler trying to jump out of the cart, then simply forget it! You will likely look for the same items and brands every week without even looking at the label.

Traffic lights work because they are simple and easy to understand. The red-yellow-green lights have become a part of our nature. This leads to automatic action, which by habit and practice, is the correct action (in most cases, unless you are drunk!). So why not use the same idea and make the decision-making simple when it comes to food shopping?

I was really excited to learn that this is exactly what many supermarkets in the UK have started doing for their store brands. The standard nutrition label has not gone away, rather there is a simple color chart on the front panel of the package showing in red-amber-green, the levels of fat, saturated fat, salt and total sugars. We know that if we want to eat a healthy diet, one of the key things we should be doing is trying to cut down on fat (especially saturated fat), salt and added sugars. The message from the traffic light label is simple and clear – choose foods that show more “greens” than “reds” if you are trying to decide between two similar products.

One of the early adopters of the traffic light labeling system recommended by UK’s Food Standards Agency (similar to our FDA) was the Sainsbury supermarket chain, which now has nearly 5000 of its own branded food products showing this front-of-pack multiple traffic light (MTL) nutritional labeling. Even better, they have now developed a new ‘Just for Kids’ multiple traffic light labelingspecifically for the nutritional requirements of children.  This is based on Guideline Daily Amounts (GDA) for 4-6 year olds. Not surprisingly, the consumer response has been overwhelmingly positive. In a recent survey, 92% of the customers found the MTL labeling easy to understand and 54% felt that MTL labeling, rather than the corresponding GDA approach, gave the“best at-a-glance indication of the healthiness of the food”. In another survey, they found that out of those aware of the MTL labeling, 57% said the symbol has helped them eat more healthy, with 17% saying it helped them eat ‘a lot more’ healthy. Clearly, the system works for most consumers.

Not everyone is equally excited of course. I was browsing through the comments on a blog post by Andrew Wadge of the FSA on this topic. Some find it too simplistic and arbitrary. Others see it as a tool to pressure the food industry to adopt a new labeling requirement. One particularly interesting criticism was that the color coding system does not work for color blind people!

Surely, this cannot be a substitute for the detailed nutrition information label. In addition to avoiding the bad stuff, we need to also look for the good stuff like proteins, vitamins and minerals. Still, I think that such a system, if adopted by the food companies here at home, could make life easier for us busy people. What do you think?

Here are a few links if you want to learn more:

1. A detailed overview on Netmums.com
2. An article on food labels from FSA
3. Sainsbury’s traffic light labeling system
4. Traffic light label adopters in UK