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, Family Physician and Registered Dietitian Dr. Shelley Meyer takes a close look at omega 3 fatty acids from natural food sources and processed foods.

Question: I am hearing a lot about omega 3 in food products. Is there a difference between added omega 3 in processed foods and omega 3 from natural food sources? Which one is better?

I am sure by now you have heard that Omega 3 fatty acids are good for you.  In fact, studies have shown that they can help reduce heart disease, lower triglycerides and blood pressure, improve osteoarthritis and rheumatoid arthritis symptoms and improve memory and brain function, especially in infants.  Some studies have also shown they can help with depression, though this is currently being debated. Animal studies have even proven that these essential fatty acids may even be able to combat breast cancer.

There are many sources of Omega 3 fatty acids, both in natural food form and in supplemental form.   Fatty fish, such as salmon, mackerel, sardines or fresh tuna, provide the most absorbable forms of omega 3 fatty acids, known as Eicosopentasoic Acid (EPA) and Docoshexaenoic Acid (DHA).  Walnuts and flaxseeds are also excellent sources of omega 3 fatty acids but in a different form, Alpha-linolenic acid, known as ALA.  However, usually only 15% and 5% of ALA ingested are broken down to EPA and DHA, respectively.  Therefore, the absorption of vegetable and non-vegetable sources of these fatty acids is not equal.

In recent years Omega 3 supplemented foods have flooded the market, with all encompassing claims of amazing health benefits.   More studies need to be done to determine if these enriched foods are equal to natural sources of fish oil, but some studies have been promising.  In fact, some small studies have shown that the omega 3 fatty acids in supplemented foods may be better absorbed than fish oil concentrates and gel capsule supplements.  This may be due to the fat contained in the food being eaten, which can help the fatty acids to be better absorbed.

In summary, omega 3 enriched foods may be just as good as natural sources of omega 3 fatty acids, but the jury is still out.   When looking for omega 3 fatty acid sources for your kids, keep in mind that the daily recommendation for children is 120 mg of DHA and 180 mg of EPA per 10 pounds of body weight.

©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.

News of vitamin D deficiency in children are popular in the media these days. Like all concerned parents, I am sure you have paused to pay attention to these news and wondered if you should get a vitamin D supplement for your toddler. The only way you can be sure whether your child has a vitamin D deficiency is by getting a blood test which screens for a particular form of vitamin D called 25-hydroxyvitamin D. Unfortunately, there are no early warning symptoms which can help you determine if you should take a corrective action.

You don’t need to go rushing for a blood test right away though! By paying attention to your child’s general level of outdoor activity and eating patterns, you can get a few clues. Here are 5 questions you can ask to figure out if there might be a need to get a definitive answer on vitamin D deficiency in your specific situation. However, you should not jump to a conclusion too soon just by observing over a few days. Rather you should try to look for a general pattern over a period of time.

Does he get enough time to play in the sun?

Your child’s body (and yours) is programmed to make its own vitamin D simply by being out in the sun. Even 10-15 minutes of play with arms and legs exposed to the sun can be enough. And best of all, the body is able to self-regulate the amount of vitamin D by storing the excess in fat cells.

The problem is that you may not get enough sunshine during the day, especially during the fall and winter months simply because of where you live. Children with darker skins are also at a disadvantage because of the pigment in their skin which absorbs the UVB rays which would otherwise be used to make vitamin D.

The good news is that the effect of sun is cumulative - that is, it adds up over time. Take advantage of every sunny day, even in the middle of winter to let your child play outside. Getting fresh air and physical exercise is good not only from the point of vitamin D, but also for overall physical and emotional health.

Does she drink at least 4 cups of milk every day?

Milk, by far, is the best source of vitamin D because all milk in the US is now fortified with vitamin D. However you need at least 4 cups to reach the recommended level of daily vitamin D (400 IU for children).

The problem could be milk allergies and just a natural dislike of milk. Also 4 cups is a lot, and even adults don’t usually get to drink that much on a daily basis. Try to mix with vitamin D fortified cereals, most of them generally are these days. You can also get vitamin D fortified orange juice, but be sure to watch out for added sugar.

One good way of increasing milk consumption is to add it to a smoothie. This way you can also get your child to eat some fruits!

Does he eat fish as part of a balanced diet?

Eating fish such as salmon is almost like buying insurance as far as vitamin D is concerned. You don’t have to eat it everyday – even once a week can work its magic. One serving of 3.5 oz (about 100g) or the size of a deck of cards can provide as much 2 times or even higher than the daily recommended level of vitamin D. Other fishes like tuna, mackerel and sardines are also good sources of vitamin D. Mercury contamination is a risk but should not be too much of a concern if you eat them occasionally as part of a varied diet.

The problem again could be allergies. Also your child may not like the taste or smell of fish. Trying new recipes and offering in small portions in combination with some of his other favorites can help you to build a taste for fish.

Does she seem overweight for her age?

Childhood obesity is on the rise and if your child is overweight or obese, you have a challenge in terms of vitamin D as well. That is because the body is not able to pull the vitamin D stored in the fat cells when needed.

Keep a close eye on her Body Mass Index by looking at the age specific growth charts. They are available on the CDC website or you can ask your pediatrician. Again, it is important to look at the trend and not a single point on these charts. If you see a trend creeping over the 85th percentile, you need to take action right away and improve the overall nutrition and eating habits of your child. Unless there is an underlying medical condition, nutrition and lifestyle changes can show good results.

Does he have special medical conditions?

In the most unfortunate situation, your child may have a medical condition such as Crohn’s disease, celiac disease or cystic fibrosis. These diseases cause poor absorption. Since vitamin D is a fat soluble vitamin, its availability is severely reduced in people suffering from these problems.

If this is the case, you are probably already talking to your pediatrician. Discuss the matter of vitamin D deficiency if you have not already done so.

After considering your specific situation, you can consult with your pediatrician about supplements. While I am not a fan of jumping on the vitamin supplements bandwagon, I think it is important to be informed about them. I plan to write about vitamin D supplements in future once I have had a chance to do some research on them.

What do you think? Are you concerned about your child’s vitamin D levels? Are you considering supplements? I would love to hear your comments.

Photo Source: Leo Reynolds on Flickr
©2009 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.

Greetings! Fall is in the air and I really love this time of the year. There is a cool, crisp freshness in the air, especially in the morning and just before the sunset. We are having a lot of fun with the twins playing outdoors in the yard or going around the block with them on their tricycles. Hopefully you all are having fun too. And yes, the Holidays are not that far off either!

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.

Maximize your child’s nutrition at every stage

Registered Dietitian Maryann Jacobsen has written a very nice and comprehensive guide to help you maximize your child’s nutrition at every stage, from birth to school years. What I liked about her post is that she describes very clearly the recommended levels of different nutrients and offers great feeding tips at every age. For preschoolers, it is important to build healthy eating habits early on by striking a balance between their desire for sugary, fatty and high energy snacks and balanced homemade meals. Eating as a family is highly recommended, although it is no easy feat to accomplish!

For school-age children, watch out for deficiencies in vitamin E, D, calcium, magnesium, potassium and fiber. Get them to eat with you as a family and encourage them to eat more fruits and vegetables.

Most of all, don’t give up, keep trying and fight the battle by being a role model.

Too much marketing hype behind probiotics

There is a lot of buzz around probiotics these days! People have been eating yogurt for a long time, but it is only recently that food marketers have realized they can make it sexier by using the immunity claim on the package. This kind of advertising is hard to resist, especially when it comes to products for kids. Even we fell for the DanActive Immunity Probiotic Drink, which claimed to have a new more absorbable yogurt culture but it contained a lot of sugar and it was super expensive. All kinds of claims are being made to pull customers. I was surprised to lean that Dannon recently settled a class-action lawsuit Activia yogurts and DanActive yogurt drinks.

When it comes to probiotics, not every strain of the bacteria is equally effective. Consumers should be informed about the specific probiotic strain in the product and its scientifically proven benefits. The L. Casei Immunitas^TM strain in DanActive drinks has been shown to reduce illness in children attending daycare. But there is very little evidence of general immunity or resistance to disease from these probiotics. In my opinion, these new products are not worth the extra money and you should watch out for added sugar. In the meantime, plain yogurt with home-made fruit puree is a very decent affordable option!

Schools start cooking fresh food for a healthier lunch

Yes there are a lot of regulations for school kitchens, there is little or no equipment and there aren’t any skilled cooks on the staff. Plus it is simply easier to serve straight out of a package after a quick reheat. No wonder over 80% of the school districts in the country cook less than half of their entrees from scratch according to a 2009 survey by the School Nutrition Association. School lunches have neither appealing nor appetizing for kids!

I was happy to read about one middle school in New York which is trying to do things differently to encourage kids to eat better at lunch. Mostly due to the efforts of its principal and the cafeteria manager, a few new ideas are being implemented. A curry chicken recipe is one such idea especially popular among the students. The bread is whole wheat, pasta is whole grain and milk is low fat. There are salad bars and deli bars. More importantly, these leaders believe that “the children need a little flair in the food, it is good for their brains”. Amen to that!

Omega-3 cheese may soon become available

A new study shows the promise of formulating cheese with fish-derived omega-3 without the fishy smell. Scientists have developed a technique to add omega-3 as an emulsion to the cheese to make it stable and mask the fishy smell. It is still at the research stage but I am sure there will soon be a commercial product given the huge consumer interest in omega-3 fatty acids. I think it is a good innovation even though only a small amount of omega-3 can be added to cheese by this technique.

Omega-3 fatty acids are called essential fatty acids because the human body cannot make them. They are good for growing children because they help in visual and brain function development. Diet and supplements are the only source of these nutrients. Cheese is popular among children, therefore omega-3 fortification of cheese makes sense. When it becomes available, watch out for saturated fats and trans fats before tossing it in your shopping cart!

A fun way to learn about nutrition

Cathy of A Life Less Sweet provided a link to Nourish Interactive, a website which is trying to educate parents and kids about nutrition by using online games. It looks very interesting, and best of all, membership is free. Parents and kids can learn together by trying out these games, puzzles and challenges. You will need to create an account for your child to play free. There are many useful interactive tools such as a healthy meal planner which helps you calculate the daily calories for different foods based on your child’s age. I plan to check it out in detail. If you do try it, let me know what you think.

Enjoy your weekend!

Photo source -chefranden on Flickr via everystockphoto
©2009 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, Dr. Douglas Husbands recommends a few good nutritional supplements for your toddler.

Question: What are good nutritional supplements for toddlers 2-5 years old?

Answer:

The majority of the research shows that nutritional supplementation is currently necessary in addition to a healthy diet to meet adequate and especially optimal nutrient requirements, of most people.  In fact, according to an article published earlier this decade in the Journal of the American Medical Association (JAMA), it is advisable for physicians to  recommend nutritional supplements to their patients and that most people require nutritional supplements to make up for the shortcomings in their diet.  Additionally because many modern farming practices often do not adequately replenish the nutrients in the soil, the vegetables and fruits grown today commonly have lower nutrient content than the same vegetables and fruits harvested many years ago. Therefore supplements for toddlers are also advisable.

Since toddlers are often picky eaters, a good multivitamin/multimineral supplement formulated for toddlers is a good start.  There are various chewables on the market which often contain some type of sugar, but you preferably want one that is lightly sweetened with xylitol rather than fructose.  Avoid any brand sweetened with table sugar or high fructose corn syrup. Xylitol is a natural sugar causing minimal changes in blood sugar and insulin levels, and does not feed the bacteria causing tooth decay.

Another good way of getting a multivitamin/multimineral supplement into your toddler is to use a powdered supplement.  This is convenient in that many of these powdered supplements can be easily dosed according to the child’s age or weight for the proper amount.  They can also be easily mixed in some of the child’s beverages or foods.  There are various brands on the market, but be sure to purchase one especially formulated for toddlers, read labels carefully to avoid those with table sugar or fructose.   Any good one formulated for toddlers will not contain iron.

One of the supplements with the greatest amount of scientific research supporting its use in toddlers and children is fish oil.  Fish oil contains the essential omega 3 polyunsaturated fatty acids docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA).   Since a large proportion of brain tissue is made of DHA, this is particularly important in the toddler years where brain growth is occurring.  Fish oil given in children is also associated with decreased risk of developing type 1 diabetes.  A study published in JAMA in September 2007 found that among 1770 infants and toddlers at high risk for developing type 1 diabetes, those toddlers who obtained supplemental omega 3 fatty acids from cod liver oil had significantly decreased risks of the development of type 1 diabetes. Approximately 1 gram of fish oil each day is beneficial for many toddler aged children.

Since cod liver oil also contains vitamin D, the beneficial effect of supplemental vitamin D is also well supported by research for being protective against the development of type 1 diabetes in toddlers and children.  Additionally, since vitamin D has multiple benefits, the latest research supports toddlers getting a total of approximately 1000 to 2000 IU of vitamin D each day.  Supplemental Vitamin D comes in different forms, but the advisable form is vitamin D3 (cholecalciferol).   Do not purchase one that is made with ergocalciferol!  Vitamin D is essential for immune function, proper bone growth, proper brain function, and proper growth hormone output, among other functions, so optimal levels of vitamin D are vitally important for healthy, happy toddlers.

Probiotics would also be among my recommended supplements for infants and toddlers.  Probiotics is a general term describing various strains of the beneficial bacteria that should reside in adequate numbers within the mucous membranes of the gastrointestinal tract.  These strains have specific names such as Bifidobacterium infantis, Lactobacillus plantarum and variations thereof.  Probiotics have many functions in supporting a healthy and balanced immune system and in supporting proper nutrient digestion and absorption. It is critically important for newborns delivered via C-section to begin probiotics, and for any infant or toddler who has been given an antibiotic to be given probiotics.  The recommended strains of probiotic and dose are dependent on the age and physical state of the child.  A knowledgeable health professional well educated and experienced in nutrition should be consulted for specific dose and strains of probiotics for your particular child.

©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.