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

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

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

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

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

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

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

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

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

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

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

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

©2010 Littlestomaks.com

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

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

Doubts emerging about restaurant calorie labeling

It has been a year since the chain restaurants in New York City started labeling their menu items with calorie content. A new report raises questions about its effectiveness in changing consumer behavior in the short term and solving the problem of obesity in the long run. New York City estimates that menu labeling will reduce the number of obese New Yorkers by 150,000 in 5 years and prevent 30,000 cases of diabetes. In a city of over 8 million people, these are small numbers; still many are questioning these estimates. Plus many restaurants seem to be “cheating” by posting lower calorie numbers than actually present in certain food items when tested. Does it mean that menu labeling does not work? I think it all depends on your viewpoint. It is not a silver bullet for the obesity problem; simply a step in the right direction. As long as it makes people think twice about buying the high-calorie food, it has a chance to change attitudes. Posting calories is just a start – in fact, complete nutritional information including salt, fat and sugar content should be made available if a consumer wants it. It takes a long time to change consumer behavior and we should keep taking small steps like calorie labeling. This is not a time to shoot it down!

Celiac disease 4 times more common today than 50 years ago

New research from the Mayo Clinic in Rochester, Minn., according to a New York Times article, suggests that today there are 4 times more diagnosed cases of celiac disease compared to the 1950′s. Celiac disease is a serious immune system reaction to gluten (protein in grains such as wheat, rye, barley) which attacks the intenstines and disrupts the absorption of nutrients. A lot of early cases or gluten intolerance remain undiagnosed. Even though the headlines seems alarming, it is still a small number. I do not mean to diminish its impact, but there is no reason to panic and stop eating wheat or other grains simply because you experience digestive discomfort a few times. Surely, you should discuss it with your doctor who can do a complete checkup. I say this because there is a lot of hype about gluten-free diet these days. Lower your intake of processed foods, and eat more whole grains. Go gluten-free only if needed, and only after consulting with your doctor.

50% of food lost from farm to fork

Amazing, isn’t it? No wonder, the food prices are so high. Improving the efficiency of our food supply chain will not only be good for the environment, it will also result in lower food prices. It strikes me as ironical that when it comes to food prices, the farmer gets the major portion of the blame. Also, the focus is on fertilizer-hungry, high-yield crops which results into a massive over-production. If only we could focus on the supply-chain efficiency, then maybe we could have a more sustainable food chain. This, and other interesting quirks of our current food supply chain are included in this entertaining video from IBM social media – check it out!

Most physicians and nurses use dietary supplements – should you?

A survey of 900 physicians and 277 nurses sponsored by the Council for Responsible Nutrition (CRN) showed that about half of the physicians and nurses used dietary supplements regularly. Overall health and wellness was the most common reason given for using these supplements. They were also quite likely to recommend dietary supplements to their patients for a variety of reasons. I think the CRN, which is a trade association representing manufacturers of these supplements, can hardly be considered an unbiased agency for this type of a study. After reading the whole report, I can also say that their sample of physicians and nurses cannot be treated as random. Therefore, the high positive response in favor of supplements cannot be considered as representative of all health care professionals out there.

Having said that, I personally take a multivitamin on a daily basis because I know that even a fruit and vegetable rich diet today is not sufficient to provide all the necessary vitamins and minerals. Our industrialized farming methods have depleted the nutritional quality of the soil, and fruits and vegetables today are not as rich in vitamins in minerals as they were several decades ago. If you are not taking a supplement, discuss with your doctor if you should. Be careful while selecting the dietary supplement – they are not regulated by the FDA and there are many quality and safety problems. Don’t fall for the out-of-the-world claims for all sorts of miraculous treatments and cures; if they sound too good to be true, probably they are. Exercise the same caution when selecting a nutritional supplement for your toddler. For more tips, read Dr. Husbands answer about toddler nutritional supplements on my Ask the Expert column.

Tips for dining out with preschoolers

Dr. Kathleen Cuneo of Dinner Together, who wrote a guest post here, alerted me to this excellent article for tips on dining out with preschoolers. We have personally experienced this challenge because we have to manage two – not one – energetic toddlers while trying to enjoy our own meal. I think her advice of having realistic expectations from your toddlers is right on the money. We have to simply accept that most preschoolers cannot sit still the whole time. This article offers 7 very practical tips you can use with your little ones. One of our tricks is that we order something for our twins right away and request that they bring it within 5-10 minutes. That’s probably the most we can keep them interested in sitting at the table without anything to eat. Once their food arrives, we order ours and feed them while it is being prepared. Of course, if the service is good, we remember to leave a generous tip.

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

Photo source -The Wandering Angel on Flickr
©2009 Littlestomaks.com

Source: noe** on Flickr

According to a recent study that looked at data for over 10,000 children between the ages of 2 – 17 years old, you are more likely to give a vitamin and mineral supplement to your child if:

• your child is between 2 – 4 years old
• your child is underweight (BMI < 5th percentile)
• your child is in overall good health and has an active lifestyle
• you have good access to healthcare
• your household income is high
• you are a non-Hispanic White

On the other hand, you are less likely to give a vitamin and mineral supplement to your child if:

• your child is overweight (BMI >85h percentile)
• your child’s overall health is generally poor
• you do not have health insurance
• your child rarely drinks milk
• your household income is at or below poverty level
• you are a Mexican American,  or non-Hispanic African American

It is quite easy to draw a conclusion that children who do not really need supplements are actually more likely to be getting them, while those who may benefit from taking supplements are less likely to take them mainly because they are poor and come from a certain racial background. Here is a headline from a recent article “Kids who need vitamin not getting them while those who get them do not need them” which seems to echo the editorial commentary in the journal Archives of Pediatrics & Adolescent Medicine where the original article is published.

In my opinion, this is an over-simplification of the real situation. This study was based on the 1994-2004 National Health and Nutrition Examination Survey (NHANES) which is claimed to contain nationally representative data on comprehensive dietary supplement use in the United States. Intake of vitamin and mineral supplements in the NHANES database was measured by figuring out if the child had used any of these supplements in the 30 days prior to the interview. Looking at the pattern of vitamin use (or non-use) over just 30 days is not enough to draw a relationship between “health” and “need” of such supplements. The effect of diet and nutritional supplements on health is slow and takes place over the long term. If a child is “healthy” at the time of the interview, and taking supplements, it does not mean that he does not need them. On the same note, if the child is not “healthy” and not taking vitamin supplements, it does not mean that the family cannot afford them. In this regard, I do not agree with the authors of this study on the implications of race and poverty.

While it may be true that if a child is growing up in an affluent family with access to good health care, the parents are well-informed and are able to afford vitamin supplements. However, it is also possible that the child is overweight or not in good health despite the use of multivitamins and regular doctor visits.

In contrast, it may be true that a child growing up in a poor family may not be getting vitamins because they cannot afford them. However, it is also possible that the parents do not simply have the right information to make an informed decision regarding the nutrition and supplements for their children.

Does it mean that you should immediately stop using your current vitamin supplement for your child? Before you jump to such conclusions based on this study, you may want to consider the following -

• While it is always recommended that your child should get all the necessary minerals and vitamins from a balanced diet which includes plenty of fruits and veggies, you should consider using supplements – and continue using them – in certain situations. I have written about them previously in my post 5 Reasons To Consider A Multivitamin Supplement.
• Consult with your doctor, especially if your child is underweight or might be at risk of vitamin deficiency either due to eating habits or a health condition. You may need to switch brands or get a prescription for a pharmaceutical grade multivitamin.
• Continue introducing more fruits and veggies in your child’s diet while keeping him on a good multivitamin supplement.  As long as you do not exceed the recommended dose, or use a mega-vitamin, this should not do any harm. Encourage a good amount of physical activity every day and reduce TV watching and computer games. Keep an eye on his growth pattern and BMI by using a growth chart. Your doctor may advise you to stop or reduce the use of supplements based on the right changes in eating habits, lifestyle and growth patterns.

What is your opinion? Would you do anything differently as a result of this report?