photo credit: sly06

A recent article in the Pediatricss journal reported data on serum levels of 25-hydroxyvitamin D, the active form of vitamin D in blood and asked this question Do Children Need More vitamin D? There is a lot of buzz in the media these days about deficiency of vitamin D, especially in kids. Beyond the screaming headlines and soundbites, it is important to look at the data an scientific way before jumping to conclusions.

In this article,  I will first provide a brief background on vitamin D and explain why it is a concern these days especially for growing children. Second, I will describe the design of the Pediatric study and methods used to analyze data. Finally, I will summarize the results to support some of the key conclusions of this study.

Let me first say that there is no consensus on the threshold level of vitamin D in blood below which a child is considered deficient. Still, the authors concluded that millions of US children aged 1-11 years may have sub-optimal levels of vitamin D, especially non-Hispanic Black and Hispanic children. However, more research is needed before a decision can be made about recommending vitamin D supplementation in children.

Vitamin D – the sunshine vitamin!

Vitamin D is produced when our skin is exposed to the UV-B rays from the sun. That is why, sometimes it is also called the sunshine vitamin. It is also available from a few limited food sources such as milk, fortified orange juice and cereals, and fish such as salmon, mackerel, cod and herring. Vitamin D supplements are also available from both synthetic and natural sources. Deficiency of vitamin D is known to cause rickets, a condition which involves bone loss and deformation. Because vitamin D is also a prohormone, meaning it is involved in proper functioning of other hormones, recent research is linking vitamin D deficiency with many other diseases like diabetes, heart disease and even cancer.

Why the concern then? Well, the problem is that many parts of the world do not get enough sunlight through the year. When we do manage to get some sun, we have a tendency to overuse sunscreen because of the risk of skin cancer. Don’t stop doing that, but be aware that sunscreen blocks the UVB rays responsible for vitamin D production. As for nutrition, we know that children are picky eaters. They hardly eat fish or drink enough milk. Junk food has little vitamin D. Because of these reasons, there is a concern that kids are not getting enough vitamin D.

The Pediatrics study analyzed 2001-2006 NHANES data for kids 1-11 years old

Because of the concern over vitamin D, the Pediatrics article is very timely. Researchers from Harvard, Mass General Hospital and University of Colorado analyzed the NHANES data from 2001 – 2006, which is collected every 2 years by the National Center for Health Statistics. The NHANES uses a 4-stage sampling strategy to represent households across the country. It tends to oversample low income groups, blacks and Mexican Americans. However, statistical methods including appropriate weights are available to extrapolate the results to a nationally representative population.

In this study, the researchers obtained serum levels of 25-hydroxy-vitamin D – the “active” form of vitamin D present in the blood. They also had household interview data about the demographic, socio-economic status and vitamin use. Sample size for kids 6-11 years old from 2001-2006 was 3421 for household interview data and 2759 for serum 25(OH)D data. Sample size for kids 1-5 years old from 2003 – 2006 was 2677 for household interview data and 1799 for serum 25(OH)D data.

Serum levels were categorized as <25, <50 and <75 nmol/L. Although, there is no consensus on what constitutes as the level of deficiency in children, the Institute of Medicine has set it at less than 27.5 nmol/L while the Canadian Pediatric Society has set it at less than 25 nmol/L. Recently, a level of less than 50 nmol/L has been found to be linked to some level of bone demineralization.  In adults, recent studies demonstrated that healthy levels of serum 25(OH)D may be as high as 75 nmol/L or even higher. That is why, the researchers decided to look at prevalence data for the nationally representative population of 1-11 years old children at these 3 different levels.

Average blood levels do not show deficiency, but experts believe most kids have lower than desired level of vitamin D

The mean serum level for children 1-11 was 68 nmol/L. Children aged 6-11 had a slightly lower mean level at 66 compared to those aged 1-5 at 70 nmol/L.

When taken as a whole, following prevalence levels were found:
< 25 = 1%, < 50 = 18% and < 75 = 69%

In terms of actual population numbers, this translates to 320,000 children below less than 25, 6.3 million less than 50 and 24 million less than 75. If the “average” values of the serum level gave you a sense of comfort, simply look at these prevalence numbers. Amazing!

If you consider the level of 75 nmol/L or higher as optimal, like most experts, the prevalence of serum levels below 75 was higher for non-Hispanic blacks at 92% and Hispanic at 80% compared to non-Hispanic white children at 59%. In terms of numbers, 2 out of every 3 children in the US are below this level, and nearly all of the non-Hispanic black and Hispanic children are below this threshold. If the threshold is changed to <50, then over half of non-Hispanic black children 6-11 years old fall in this category.

The current daily recommended intake from the Academy of Pediatrics is 400 IU/day. Experts believe that this is insufficient to raise the serum levels to >50 or >75 and that vitamin D supplementation may be needed in at-risk populations.

More vitamin D is good for children, but do not jump to supplements right away!

Coming back to the original question “do children need more vitamin D”, the short answer is YES. It may be tempting to simply get on a daily supplement. But I think we should try to first make small changes in our lifestyle and eating patterns. Nature did not intend us to be deficient in vitamin D, even though she gave us all a different skin color. The fact that we see low numbers in our population is a result of our lifestyle and poor diet. Get active, get outdoors – even 10-15 minutes of sun exposure on your arms and legs without sunscreen is enough. Of course, you should worry about skin cancer and use sunscreen before it is too late. Get your kids to eat healthy including a diet rich in dairy and fish unless there is an allergy problem. There are many natural ways to ensure your child gets enough vitamin D before deciding to take a supplement.

Parents – are you concerned that your child may have a vitamin D deficiency? What steps are you planning to take? Share in your comments below.

©2010 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

There is a lot of buzz about vitamin D deficiency these days. According to some reports, 40% of US infants and toddlers are not getting enough vitamin D which increases their risk of a variety of health conditions. No doubt, vitamin D is very important for health,  especially for growing children. That is why it is good to pay attention to your child’s needs but there is no need to panic. In the past, I have written several articles on vitamin D including 5 ways to tell if your child may have a vitamin D problem. Here, a few quick facts about this important vitamin:

1. Vitamin D actually is a prohormone; which means that it is converted into a hormone inside the body. In this way, it is different from all other vitamins.
2. Vitamin D is produced when our skin is exposed to UVB rays from the sun.
3. There isn’t enough UV energy above 42 degree north latitude (a line between northern California and Boston) during November to February to produce any vitamin D in the skin. In places farther north, this can last nearly 6 months during the year.
4. Vitamin D from food or supplements comes in 2 forms – vitamin D2 or vitamin D3.
5. Vitamin D3 is 3 times more effective than vitamin D2 in maintaining blood levels of the active form of vitamin D.
6. Vitamin D is fat soluble and any excess from sun exposure or diet is stored in fat cells available for release when blood levels fall low especially during winter months. This does not, however, happen very easily in overweight or obese individuals.
7. American Academy of Pediatrics recommends a daily value of 400 IU for young children. You can get this amount from 4 glasses of milk or vitamin D fortified orange juice, 1.5 oz of cooked salmon, or about a third table spoon of cod liver oil.
8. Vitamin D deficiency causes rickets in children. Recent research indicates a link between vitamin D deficiency and diabetes, heart disease and certain types of cancers.
9. Blood levels of less than 20 ng/ml are considered to indicate vitamin D deficiency.
10. Mushrooms when exposed to UV light during production are rich in vitamin D2.

Source: Vitamin D Dietary Supplement Facts Sheet from NIH

Just like thiamin and riboflavin, which I wrote about recently, niacin is another B vitamin commonly found in fortified foods such as cereals, breads from enriched flour, pasta, sauces, baby foods, energy drinks. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Niacin?

Niacin is also known as vitamin B3, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Sometimes, the word niacin is also used for nicotinic acid and nicotinamide or niacinamide. It can get very confusing, especially because most fortified foods contain nicotinamide as a nutritional supplement and the ingredient list may not explicitly show niacin. Although they are chemically different, the thing to remember is that they all do pretty much the same thing inside the body.

Niacin, like the other B vitamins, is soluble in water. Just like riboflavin, niacin is also involved in production of energy at the cellular level. It is also responsible for synthesis of fatty acids, cholesterol and steroids. Even more importantly, it is involved in gene expression, that is production of proteins when genes become active. When taken as a medical treatment, niacin lowers bad cholesterol (LDL) and increases good cholesterol (HDL) and reverses the clogging of arteries. Of course, you should not rely on supplements to achieve this effect if you have a cholesterol problem; you need to see a doctor!

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, niacin is involved in the conversion of carbohydrates, fat and protein into energy required for cell functions. It plays an important role in regulating your child’s metabolism and growth.

There is some recent research which shows a preventive effect of nicotinamide for type I diabetes. The data is far from conclusive, so you should talk to your doctor if you suspect your child might have a risk of type I diabetes because of family history or another medical condition.

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

For infants, the FDA has recommended a daily amount of 8 mg. And for toddlers less than 4 years old, the recommendation is 9 mg. Pregnant and nursing women are recommended to take about 20 mg per day. Healthy adults are also advised to take about 20 mg per day.

Niacin is usually present in meat, poultry, yeast, fish (salmon, tuna), whole grains, fortified cereals, breads made from enriched flour. Leafy green vegetables and milk also provide some niacin.  Here are a few examples of different food sources and amount of niacin per serving (source: wikipedia and Linus Pauling Institute):

1. Chicken, 3 oz (deck of cards), cooked = 7.3 mg
2. Turkey, 3 oz = 5.8 mg
3. Salmon, 3 oz = 8.5 mg
4. Fortified breakfast cereal, 1 cup = 5 mg
5. Portabella mushrooms, 3.5 oz = 3.6 mg
6. Lentils, 1 cup = 2.1 mg
7. Hazelnut, 100 g = 1.5 mg
8. Peanuts, 1 oz = 3.8 mg
9. Broccoli, sweet potatoes, carrots = 0.6 – 1.2 mg
10. Avocado, 100 g = 1.7 mg

It is not common  to get excessive amounts of niacin from food sources.

What happens if my child does not get enough niacin?

According to the PDR for Nutritional Supplements, niacin deficiency causes pellagra, which these days is very rare in the developed countries. In the old times, pellagra was a condition that resulted in dermatitis, dementia and diarrhea and even death.

Should I be concerned about niacin deficiency?

The short answer is no. There is a risk with corn rich diets unless the corn is processed in a certain way to release the niacin from its bound form. Too many refined carbohydrates, unless enriched with niacin – which they commonly are – can also present a risk. If you have known problems with digestion and absorption of food,  your doctor can advise a proper treatment including supplements.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough niacin?

©2010 Littlestomaks.com

Just like thiamin, which I wrote about recently, riboflavin is another B vitamin commonly found in fortified foods such as cereals, enriched flour, pasta, sauces, baby foods, energy drinks.  In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. I am following up on my article on vitamin A from a few weeks ago. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Riboflavin?

Riboflavin is also known as vitamin B2, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Riboflavin, like the other B vitamins, is soluble in water. Cells in our body need energy produced by special biochemical reactions. Certain types of enzymes help these reactions happen, but they too need help from coenzymes produced by riboflavin. Obviously, this is very complex chemistry, but the point is that riboflavin is an important player in the chemical reactions that produce energy at the cellular level. Recently, high doses of riboflavin have been found effective in preventing migraine headaches. Seek medical advice before using riboflavin for migraines.

It is also used as a food coloring because of its yellow or yellow-orange color. The more soluble riboflavin 5′-phosphate is called the E101 food color.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, riboflavin is involved in the conversion of carbohydrates, fat and protein into energy required for cell functions. Riboflavin also has antioxidant activity which protects your body from reactive oxygen radicals. Just like the other B vitamins, riboflavin plays an important role in your child’s metabolism.

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

For infants, the FDA has recommended a daily amount of 0.6 mg. And for toddlers less than 4 years old, the recommendation is 0.8 mg. Pregnant and nursing women are recommended to take about 2  mg per day. Healthy adults are advised to take about 1.7 mg per day.

Riboflavin is usually present in most plant and animal food sources although in small amounts. Yeast extract is exceptionally rich in riboflavin, and organ meats like liver and kidney are also good sources. Here are a few examples of different food sources and amount of riboflavin per serving (source: wikipedia and Linus Pauling Institute):

1. Cooked spinach, half cup = 0.2 mg
2. Asparagus, about 6 spears = 0.14 mg
3. Almonds, cooked, 1 cup = 0.8 mg
4. Fortified breakfast cereals, 1 cup = 0.5 – 2.0 mg
5. Milk, 1 cup = 0.34 mg
6. Egg, cooked, 1 large = 0.27 mg
7. Cheddar cheese, 1oz = 0.11 mg
8. Fish, salmon or halibut, 3 oz (deck of cards) = 0.1 mg
9. Chicken/beef, cooked, 3 oz = 0.16 mg
10. Bread, whole grain or enriched flour, 1 slice = 0.08 mg

Riboflavin is destroyed by ultraviolet light. As you can see, riboflavin is naturally available in many common food sources. There is really no need to look for a nutritional supplement for riboflvain although you will find many multivitamin products on the market. Check out my review of some of the popular kids brands of multivitamins.

Riboflavin is well tolerated without any adverse effects. There is no reason, however, to take a high dose of riboflvain supplement.

What happens if my child does not get enough riboflavin?

According to the PDR for Nutritional Supplements, riboflavin deficiency (also known as ariboflavinosis) can cause any of the following conditions:

1. Cracked or sore lips, especially on the outer corners
2. Sore throat, redness or swelling of the lining of the mouth
3. Magenta tongue
4. Skin lesions, dermatitis
5. Poor iron metabolism and absorption, lower hemoglobin levels
6. Vascularization of the cornea

These symptoms are medical conditions and should be interpreted by a doctor. It is not common for riboflavin deficiency to occur in isolation. Usually it happens when a lot of other vitamins are also absent because of poor nutrition, digestive disorders or other medical conditions.

Should I be concerned about riboflavin deficiency?

Since riboflvain is commonly available in many foods and cereals, it should not be a big concern. However, if your child’s diet is mainly junk food and not enough whole grains, nuts, fruits and vegetables, you may want to pay attention to his overall vitamin B needs.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough riboflvain? Do you have recipes that use food sources rich in riboflavin? I would love to hear from you!

©2010 Littlestomaks.com

If you read nutrition facts labels, especially on breakfast cereals, you may have noticed thiamin in the long list of vitamins and minerals. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. I am following up on my article on vitamin A from a couple of weeks ago. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Thiamin?

Thiamin is also known as vitamin B1, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Thiamin, like the other B vitamins, is soluble in water. It was one of the first chemicals to be considered a vitamin early in the 1930′s when researchers discovered that thiamin deficiency caused beriberi (also known as extreme weakness). People with beriberi have difficulty standing, walking and controlling their muscles.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, Thiamin is involved in the conversion of carbohydrates into energy required for cell functions. It also helps convert some of the amino acids into proteins.

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

For infants, the FDA has recommended a daily amount of 0.3 – 0.5 mg. And for toddlers less than 4 years old, the recommendation is 0.7 mg. Pregnant and nursing women are recommended to take about 1.7 mg per day. Healthy adults are advised to take about 1.5 mg per day.

The best sources of Thiamin are whole grain foods and fortified cereals. Most cereals are fortified thiamin hydrochloride and thiamin mononitrate (check the label). Here are a few examples of different food sources and amount of thiamin per serving:

1. Whole wheat bread, one slice = 0.1 mg
2. Brown rice, cooked, 1 cup = 0.19 mg
3. Enriched white rice, cooked, 1 cup = 0.26 mg
4. Fortified breakfast cereals, 1 cup = 0.5 – 2.0 mg
5. Lentils, cooked, 1 cup = 0.17 mg
6. Pork chopped, cooked, 3 oz = 0.8 mg
7. Orange juice, 1 cup = 0.1 mg
8. Sunflower seeds, 1/4 cup = 0.8 mg
9. Spinach, cooked, 1/2 cup = 0.09 mg
10. Wheat germ cereal, 1 cup = 4.47 mg

As you can see, thiamin is naturally available in many common food sources. There is really no need to look for a nutritional supplement for thiamin although you will find many multivitamin products on the market. Check out my review of some of the popular kids brands of multivitamins.

Research has not shown any harmful effects of overdose of thiamin from foods or supplements. Oral thiamin is well tolerated upto 200 mg daily or higher (it is over a 100 times more than the recommended value). There is no reason, however, to take a high dose of thiamin supplement.

What happens if my child does not get enough thiamin?

According to the PDR for Nutritional Supplements, thiamin deficiency can cause any of the following conditions:

1. Cognitive and emotional changes – in short, it may affect memory and mood.
2. Although anemia (decrease in number of red cells) is not a direct result of thiamin deficiency, certain kinds of anemia respond well to thiamin treatment. It is understood this could be due to reduced absorption of thiamin or problems in conversion of thiamin inside cells.
3. Extreme deficiency of thiamin causes beriberi. Dry beriberi affects the muscles in the lower legs and feet. Wet beriberi involves the heart and blood circulation. The most extreme form of wet beriberi is called Shoshin beriberi, which can result in death if not promptly treated. Another form of beriberi is cerberal beriberi (Wernicke-Korsakoff) which affects the nervous system and causes problems with eye movement and even mental health.
4. Although not well-researched, some people think that thiamin deficiency may be involved in ADHD.

Thiamin deficiency is generally a problem with severe sustained malnutrition and alcohol abuse. Most healthy kids and adults with normal eating habits and lifestyle should not have to worry about it.

Should I be concerned about thiamin deficiency?

Since thiamin is so commonly available in many foods and cereals, it should not be a big concern. However, we live in the world of fast food which is usually made from refined carbohydrates. Refined carbohydrates, unless enriched, do not contain enough thiamin. In fact, the reason why they found out about beriberi was because it was first seen in people of Asia who mainly ate polished rice. If your child’s diet is mainly junk food and not enough whole grains, nuts, fruits and vegetables, you may want to pay attention to his vitamin B needs.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough thiamin? Do you have recipes that use food sources rich in thiamin? I would love to hear from you!

©2010 Littlestomaks.com

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

Vitamin D is big business these days

According to the Nutrition Business Journal quoted in a recent New York Times article, consumers gobbled up $235 million worth of vitamin D supplements in 2008 compared to a mere $41 million in 2001! Also, more physicians are ordering vitamin D tests for their patients and prescribing supplements to correct for low vitamin D levels.

This is incredible! Clearly, there is a buzz about vitamin D these days. Screaming headlines about low levels in children and adults followed by all kinds of studies claiming a “role” of vitamin D in diabetes, heart disease and cancer are creating a mass hysteria. The message is – pay attention to your vitamin D level and start loading up on it just in case because otherwise you will have a high risk of getting these terrible diseases. This is quite misleading in my opinion.

I am not against taking a vitamin D supplement. But there are  few things you should consider before you take that step.

There is a reason why the current recommendation of 400 IU per day of vitamin D has not been revised. A lot of people believe that this amount is too low. Still, there are no clinical studies which show a prevention or treatment effect of vitamin D for these diseases. Taking high doses of vitamin D (like 1000 or 2000 IU per day) is no guarantee of good health and prevention of diseases if the overall nutrition and lifestyle is poor. Supplements are not a drug folks, even though some people may try to sell them to you like that.

Bottom line – rely on food sources for your vitamin needs first, not on supplements. And if you do have a medical condition, talk to your doctor and ask for a pharmaceutical grade vitamin supplement. Here are 5 ways to tell if our child may have a vitamin D problem.

Tax soda like cigarettes – here we go again

The state of New York is on a mission to tackle the problem of obesity. While it is a worthwhile goal, which will surely have a positive impact on long term public health and healthcare costs, their approach to solving this problem is not smart at all. In fact, I think it is driven purely by politics and motivated by their deficit problem.

Tax sugar sweetened beverages (SSB) including soda they say, because that will cause people to drink less of it, which means they will not become overweight or obese since SSB’s are known to cause obesity. They have released a sugar sweetened beverage tax toolkit to provide a rationale for this tax, which in my opinion is a lot of mumbo-jumbo and twisted logic. Still, it makes an interesting read and gives you an insight into the limited range of creativity among public health officials and regulators.

I no fan of soda. But I am totally against another tax in the name of trying to improve public health when the real motivation is to fix the deficit problem. I continue to believe that soda tax will do nothing to reduce its consumption, at least not in any significant way. There are many other ways to discourage soda makers to produce healthier products or encourage the public to limit their soda consumption. But then they are not as easy as slapping another tax!

Manage salt for better health

Salt is something we can’t live without. It is also something we consume too much of and – if we continue this way – there is little doubt that most of us will not live long enough to enjoy it for long. Dr Ayala has a nice article this week on her blog about how too much of (cheap) processed food in our diets is causing us to consume way too much than just a pinch of salt we need for good health. It is a great reminder because this week is world salt awareness week.

The food industry is taking notice. Many companies are quietly working on reducing the sodium content of their products while preserving taste and texture. New salt reduction technologies are being developed and deployed in these products. Some may still have an issue with it; but I have a more pragmatic approach. There is a reason why processed food sells – it offers convenience at a reasonable price. There is no reason to completely eliminate it, just balance it with more cooking at home, read the nutrition facts labels and select the right products. Try to limit daily sodium to less than 2300 mg (1 tsp of salt) and avoid products where a single serving has any more than 15 – 20% of this daily value. Another thing you can do is to reduce the portion size of these foods both at home and in restaurants.

5 out-of-the box ideas for helping your kids eat well

Jenna of KidAppeal has a great blog post this week with a few out-of-the box ideas for you if you need help getting your kids to eat well (who doesn’t!). I really liked her idea of “making food relevant” and “having fun”, because you do need to be able to engage them at the table. We have recently discovered that story telling works with our twins in capturing their attention long enough for them to try the food at the table. Talking about diesel food for a diesel engine does not make sense to an adult, but it captures my son’s attention! You can also play a game, read from their favorite book, solve a puzzle or simply have a conversation about what they did at school or daycare. It will help if the TV is off so they can focus on you and the food.

By the way, Jenna has a weekly feature Big Words Little Foodies every Tuesday where she invites parents to share funny things their kids say about food. Check it out and share your funny stories!

Food rules from Michael Pollan

“Eat food. Not too much. Mostly plants”. This is the essence of Mr. Pollan’s message in his new book Food Rules – An Eater’s Manual which gets a nice review in this week’s New York Times. I think this is sound advice, one that was commonly practiced as late as just a few generations ago prior to the modern day (processed) food revolution. But it also requires not only a change in your mindset about food but also a change in lifestyle. Giving up the western diet (meat, refined sugars, fat and salt via processed food) may sound simple in a book, but difficult to accomplish and sustain unless you make significant changes in your lifestyle.

What food rules do you live by these days? What changes, if any, do you plan on making in the near future?

Enjoy and let me know what is on your mind.

Photo Source: adactio on Flickr via everystockphoto
©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 Liz Marr explains why you need to exercise caution when considering a multivitamin for your child.

Question: How important is taking daily multivitamins and when should kids start?

Answer:

While parents may worry that their toddlers are not taking in adequate nutrients, normal, healthy children, even picky eaters, typically don’t need multivitamin supplements. According to the American Dietetic Association, the best strategy for meeting nutritional needs, for children and adults alike, is eating a wide selection of nutritious foods. Studies suggest that positive health outcomes are related more to overall dietary patterns rather than intakes of individual nutrients. Foods contain an array of health-promoting substances beyond vitamins and minerals, for example flavonoids.

Parents believe supplements provide children nutrients that may be lacking in their diets, according to research. However, by introducing supplements at an early age, parents may be unwittingly sending the message to children that supplements are a substitute for healthful eating patterns.

No solid evidence exists that children’s health is improved by multivitamin supplements. Nonetheless, about one third of children in the United States take multivitamin supplements. However, that figure is down from the 1970s. Compared to infants and adolescents, children ages 4-6 are most likely to take supplements. Interestingly, national surveys suggest that supplements may be taken by those who have healthful diets and lifestyles more often than those at a greater risk for vitamin and mineral inadequacies.

Because many foods that are consumed by children are already fortified with various vitamins and minerals, children are probably consuming more nutrients than parents might think. For example, many foods common in children’s diets are typically fortified, including breakfast cereals, breads, dairy products and juices.

One nutrient for which some infants and children may require supplementation is vitamin D. Because of the role of vitamin D in healthy bone formation, the American Academy of Pediatrics recommends 400 IU of supplemental vitamin D for the following:

• Breastfed infants
• Non-breastfed infants consuming less than one quart of vitamin D-fortified formula
• Children consuming less than one quart of vitamin D-fortified milk
• Adolescents with intakes less than 400 IU per day.

So, if parents choose to give children multivitamins, they should make sure the supplement contains vitamin D.

A particular caution with keeping multivitamins (children’s or adult’s) in the house with young kids, is risk of overdoses. Of particular concern with multivitamins is iron, an overdose of which can be fatal. Many children’s vitamins are designed for kid appeal, available in a variety of colors, flavors and branded characters. And children may view them as candy. If parents choose to keep multivitamins in the house, the supplements should well out of reach of young children.

©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.

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 Cindy Williams offers practical tips to help you get your growing toddler to eat a variety of foods including fruits and vegetables.

Question: How do I get my 3 year old to eat better? He never eats veggies and only eats a handful of items like chicken nuggets, pizza, pasta, rice, and cereal.

Answer:

Toddlers are notoriously fussy eaters. There are a couple of reasons for this. First, their growth rate has slowed so they usually don’t need to eat so much.

Second, as we fret about the nutritional inadequacy of two bites of toast for breakfast and desperately cajole them to eat a bit more, our darling child learns that with one tiny word – NO – they can make mummy and daddy act really funny. And if they keep on saying it long enough they might get really yummy stuff to eat. This is when the frazzled parents finally give in to the child’s incessant tearful demands for his favorite food and think ‘At least he’s eating something’. What can we do to win this power battle and come through it with a healthy child that eats a wide range of foods? Here are a few ideas.

1. Serve one new food at a time, along with familiar foods. Include one favorite food with each meal.
2. It can take up to 15 tries of a new food for your child to like it. Don’t give up on the first refusal. Try again in a few days.
3. Just like adults there will be some foods that your child won’t like even after 15 tries. Take a break and try again when they are a little older and their taste-buds have developed a bit more.
4. Add vegetables to the favorite foods e.g. pizza topped with cooked spinach, finely chopped red pepper or broccoli or pasta topped with thick vegetable soup as a pasta sauce.
5. Hide vegetables in favorite foods e.g. grated carrot and pumpkin in pasta sauce, mince and burgers. Fried rice with egg, corn, red pepper and carrot.
6. Try corn on the cob. Cut a cob in three to make it easy for little fingers to handle.
7. Toddlers can’t eat huge meals. Give them small snacks through the day. Try carrot sticks, baby tomatoes, cut fruit pieces, grapes and cheese cubes.
8. Try it raw. Serve raw sliced vegetables for your children to nibble while you make dinner. They may eat their whole vegetable quota before the meal.
9. Turn food into play. Give food fun names e.g. ‘moon squirters’ for baby tomatoes. Arrange food to look like a face, a house, a rocket ship or a train. My 4-year-old ate a pile of mashed potato with fish and vegetables because it was called ‘Tracey Island’ from Thunderbirds!
10. Make finger food. Toddlers prefer distinctive pieces of food that they can identify and pick up in their fingers.Eat as a family when possible. Children learn by example. If they see their parents and older siblings enjoying vegetables and other healthy food they are more likely to want to try it.
11. Involve your child in growing or picking fruit, vegetables and herbs. Taste it right there in the garden. It’s much more fun than eating at the table.
12. Point out interesting fruit and vegetables in the supermarket and let your child choose one to take home.
13. Let your child help out in the kitchen. They could drop tomatoes in the salad, shell peas, peel a banana, drop fruit into the blender or turn it on when making a fruit smoothie, pat out some pizza dough or sprinkle cheese.

REMEMBER…

You are not a restaurant

When a toddler complains that they don’t like their meal and that they want something different, empathize with them but don’t jump up and make something else.

You provide the quality, they choose the quantity

Young children are perfectly designed to eat when they are hungry and stop when they are full. They may miss a meal in protest at the ‘yukky’ food but their rumbling tummy will eventually have them eating whatever you have provided.

My niece went through this fussy stage as a toddler. One evening came the final showdown. She refused her dinner and demanded something else. Her dad told her that was fine; they would just keep it for her breakfast. Off she went to bed with no dinner and lots of tears, much to the horror of her mom. The next morning dinner was waiting. She refused it. Off they went to church. The dinner went too! Finally she gave in and the battle was won. Hopefully you won’t need to be this brutal, but it worked.

If necessary, give your child a temporary nutritional supplement

If you’re concerned that your fussy toddler isn’t getting enough nutrients, particularly iron which is critically important at this age, give him a temporary nutritional supplement. Nutrient fortified milk is great. Also give him fruit with his meals to increase iron absorption. Once you feel assured that he’s getting all his nutritional needs, you are less likely to fall into the ‘At least he’s eating something’ trap. You’ll be ready to take back the reins of power.

It’s a stage that will end

Hang in there. Keep serving up a variety of food and flavours. Take a few deep breaths, perhaps a glass of wine, and know that this stage won’t last forever.

©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.

Plenty of news about deficiency of vitamin D in children these days and plenty of advice on how to get it from foods like fish and milk or supplements. But did you know that UV light zapped mushrooms are full of vitamin D? UV light from the sun is what makes vitamin D in our own skin. This is a great way to enhance the vitamin D content of mushrooms without any additives. Mushrooms are also a good source of vitamin B, iron, protein and fiber.

This is good news for those who may be allergic to fish or dairy, or simply want to look for more options before getting on the vitamin D supplements bandwagon. The US Department of Agriculture has been actively developing a method to treat common mushrooms (white, portobello etc.) with help from Monterey Mushrooms, a large national-level producers of fresh mushrooms. Although, we have not stumbled upon it in our local store, they now have the  Sun Bella brand UV-treated mushrooms available in major supermarkets nationwide.

There is another competing method of treating mushrooms using high energy flashes of UV light. This patent-pending method has been developed by the Xenon Corporation and used by Dole in treating their portobello mushrooms. I am sure they will soon hit the store shelves all over if not already there.

The reason it works is that mushrooms contain a sterol (a class of chemical compounds, for example cholesterol) called ergosterol, which is converted to vitamin D2 (also known as ergocalciferol) when it is exposed to UV light. It appears that a strong focused exposure to UV light is needed for conversion because it does not happen on its own when mushrooms are cultivated.

The other form of  vitamin D available from food, especially animal sources, is vitamin D3 (also known as cholecalciferol). Vitamin D3 is more effective than vitamin D2 in raising the blood levels measured in a typical test.

I think this is great news, although I am sure these companies will charge a premium for the vitamin D “enhanced” mushrooms. Look for them in your supermarkets and let me know if you come across any other brands.

Photo source: Wikimedia
©2009 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

The media was abuzz this week with screaming headlines warning us of widespread vitamin D deficiency in kids. It followed a recent paper in the Pediatrics journal by researchers at the Children’s hospital in Boston, Massachusetts General Hospital, Harvard Medical School and the University of Colorado. The paper presented their research based on the 2001-2004 NHANES survey and posed the question Do Children Need More Vitamin D?

That the mainstream media latched on this latest research and gave it prime time coverage is not a surprise to me. I have written about such attention grabbing headlines on vitamin D before. I am so intrigued by the popularity of this topic in the press that I decided to look at this week’s news in more detail for today’s Five for Fridays. I would love to hear your comments and concerns about vitamin D for your children.

Here are 5 reasons why I believe we don’t need to let the mass media engulf us in mass hysteria about vitamin D:

There is no consensus on healthy levels of vitamin D in children

The Pediatrics paper correctly points out that:

There is controversy, however, about what a healthy level of 25-hydroxyvitamin D is for children and even what level of 25(OH)D should be used to define vitamin D deficiency

25-hydroxyvitamin D is what they measure in the blood to determine the level of vitamin D. Different agencies have defined vitamin D deficiency as blood levels less than 27.5 to 37.5 nmol/L. Many experts today believe that these levels are too low and should be revised to less than 50 nmol/L or even 70 nmol/L. By raising the number on the “safe” level, these experts suggest that a lot more people should be considered vitamin D deficient compared to current standards.

While there is some data to suggest various benefits of higher levels of vitamin D in adults (75 to 100 nmol/L), there is no such evidence and consensus for children. When even experts cannot agree on “safe” levels of vitamin D in children, I am not sure if it makes sense to raise a red flag based on this week’s report.

Average vitamin D levels in children are much higher than currently recommended

Amazingly, the Pediatrics paper reports that the average blood level of 25-hydroxyvitamin D was 70 nmol/L. Further, prevalence for levels less than 25 nmol/L was only 0.7% and that for levels less than 50 nmol/L was 15%. It is only when you consider a level of 70 nmol/L as the “safe” level that the prevalence goes up to 65%. Basically that means that most children have a sufficiently high level of vitamin D.

I am not suggesting that we should not worry about the 15% or so who had levels lower than 50 nmol/L. It is a cause for concern, but probably not as much as the rate of childhood obesity. The problem I have with these studies is that they tend to look at only one thing at a time and lose the big picture on our children’s health.

Perceived risks based on geography and ethnicity do not justify broad changes

We have all heard the usual reasons for low vitamin D – children do not get enough time in the sun which makes things worse for dark-skinned children of Hispanic and African-American background. Also children who live in the Northern altitudes do not get enough sun particularly in the winter months.

These observations are all true. However, aside from skin color and average sun exposure there is also an effect of poor nutrition in general. It is probably not a conincidence that children in these same demographic groups have also been reported as either overweight or obese. Under these circumstances, even if these children were put on vitamin D supplements, I am not convinced that it will do anything to improve their prospects of future health. I think that a narrow focus on vitamin D misses the big picture on children’s nutrition.

Based on these studies alone, I don’t think a sweeping across the board recommendation of higher vitamin D can be justified.

There is no evidence for preventive powers of vitamin D by large randomized clinical trials

A fascinating article appeard in last week’s Financial Times which posed the question To D or not to D? Recent research reports a link between higher vitamin D and lower risk of certain types of cancer. On the flip side, low levels of vitamin D have been reported to increase the risk of osteoporosis, heart disease, multiple sclerosis, type 1 diabetes, depression and rheumatoid arthritis. One recent review of health records of over 13000 Americans found that people with the lowest vitamin D levels were 26% more likely to die in an 8 year period compared to those with the highest levels.

How can you not have the sense of urgency about recommending everybody to have higher vitamin D? It seems like a no brainer.

Not so fast say the international health authorities! Even the International Agency for Cancer Research of the WHO issued a report last year that basically concluded there was no need to raise vitamin D recommendations. The Institute of Medicine in the US also does not appear to be in any hurry to change the current recommendations.

The main reason for this reluctance is that the preventive power of vitamin D has not yet been proven by large scale randomized clinical trials. The Financial Times article provides a good understanding of why such clinical trials may never take place. There are some clinical trials going on for senior citizens, but nothing on the horizon for children or young adults.

I am impressed by the commitment of today’s vitamin D researchers. However, I think there ambitions are out of proportion with their findings. I have nothing against targeted intervention in high risk groups, but it is meaningless to stretch the recommendations to everybody across the board.

These studies imply relying on supplements instead of nutrition and active lifestyle

Finally, this is the main reason why I am not a big fan of these studies. The underlying implication is that we can easily solve this problem by vitamin D supplements. The Pediatrics paper asks the question:

Considering these prevalence data, would there be risks associated with recommending that all children have vitamin D supplements until the short- and long-term health outcome data are elucidated?

It does address the concern about vitamin D toxicity but suggests that it is rare and happens only when really excessive doses of vitamin D are taken. Clearly, their agenda is to promote vitamin D supplements for children:

As suggested recently by the Canadian Pediatric Society and a recent stateof-the-art review on vitamin D, higher supplement doses may be required for children to reach the safe and potentially healthier levels of 25(OH)D of <50 or <75 nmol/L.

I think there is a real danger in such linear thinking. Instead of promoting healthy nutrition and physical activity first, and nutritional supplements second, the supplements are considered a primary means to good health. I reject that notion even though these studies get very high profile coverage in the press.

I am glad that a few Moms I talked to on Twitter about this topic calmly suggested that the real solution is to get your children to eat well, drink plenty of milk and play outdoors. At least they are not falling for this propoganda!

Have a good weekend and do let me know what is on your mind.

Photo Source: Wikimedia Commons
©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 provides an update on nutritional supplements with practical application for the health of your children.

Question: What is the latest development in nutritional supplements for children?

Answer:

Hello everyone!  I’m delighted for my second opportunity to guest post here.  Since I just recently came back from the 2009 International and American Associations of Clinical Nutritionists Scientific Symposium, I’d like to share some information on nutrition supplements with practical application for the health of your children.

Vitamin D3

• Adequate to optimal levels of serum vitamin D levels in infants and children (between 30 to 60 ng/ml) are associated with decreased asthma and allergies, better brain development and healthy bone development.
• When visiting your pediatrician or Functional Medicine doctor, serum 25-hydroxyvitamin D levels should be measured.
• It is estimated that between 50,000 to 70,000 deaths per year from various causes could be prevented by having adequate blood vitamin D levels.
• Many infants and children could benefit from supplementing with 1000 to 2000 IU of vitamin D daily, particularly during the winter months, if they cannot tolerate fatty fish, if they are darker skinned, or if their serum vitamin D levels are below 30 ng/ml.

Probiotics

• Probiotics help decrease abnormal intestinal permeability, or “leaky gut”.
• The appendix’s function is now known.  It is a repository for beneficial bacteria (probiotics) for the GI tract.  Supplemental probiotics help replenish the repository after antibiotic use or from use of corticosteroid creams or inhalers.
• Abnormal intestinal permeability allows gut-derived antigen exposure to the bloodstream; thereby distant, seemingly unassociated autoimmune symptoms can arise from a “leaky gut”.
• Due to immature GI tract development, it is best that infants are breastfed for at least his/her first 12 months.
• Many pregnant women and breastfeeding mothers would do well to supplement with the probiotic strain Lactobacillus GG (aka Lactobacillus rhamnosus) at a dose of 4 billion/day and Vitamin D3 at a dose of 4000 IU/day for potentially decreasing likelihood of asthma, eczema, allergies, type 1 diabetes, and autoimmune disorders in their babies.

Curcumin

• Curcumin, a component of turmeric, has powerful anti-inflammatory properties to inhibit inflammatory mediators, exhibiting therapeutic potential in asthma (and other inflammatory disorders)

©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.

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, published author and Reflux expert Jan Gambino offers some tips for getting your picky eater to eat regular foods.

Question: I am at my wit’s end with my picky eater! Can you give some advice on how to get her to eat regular food?

Answer:

Your baby used to eagerly anticipate every scoop of pureed peas and creamed spinach. If you didn’t scoop the food fast enough, she would yelp and complain. After the jars were empty, she was content to drink an entire bottle. Now your toddler turns away when you present anything green and healthy and shrieks with anger if you dare put a new food on her plate. A “meal” consists of a few bites of chicken nuggets and a sip or two of milk from a cup before she leaps up to chase the dog or rearrange her toys. So what happened?

Along the way, your baby has turned into an independent, opinionated little person called a toddler! She has learned to control her world in such grand ways-from crawling to walking and then climbing, offering new ways to challenge herself. Communication has taught her the power of words with “no” being the one that really tickles her! She is finding that she has the ability to make decisions and communicate her wants and needs.

She is beginning to get longer and leaner too. The rapid growth of the first year is slowing down and her body is changing. So are her eating habits. It makes sense that she will use her new skills to explore new ways of eating.

Toddlers are often labeled as picky eaters. A picky eater is a child who eats only a few foods from a few food groups. For instance, a child may eat 5 foods over and over again. Typically a picky eater will crave carbohydrates and omit fruits and vegetables. I call this the “White Diet” or “Prison Diet”. During the toddler years, my daughter was on the White Diet and would only eat chicken nuggets, mashed potatoes, crackers and dry cereal. I was worried that she was missing vital vitamins and nutrients from her limited eating. The pediatrician assured me that this was very common and somehow, most children continue to grow and thrive despite such a limited diet.

Top Tips for Coping with a Picky Eater:

1. Leave your emotions at the Kitchen Door: Remember, picky eating is normal and she will most likely emerge from this stage and expand her diet. Try not to show your anger or disappointment about her picky eating. Do not negotiate, offer bribes or withhold dessert. This just fuels the fire.
2. Routines: Try to eat at least one meal per day as a family. Little ones model our behavior whether we want them to or not. Maybe if she sees you eating fruits and vegetables over and over again, she will eventually decide to try some.
3. Kitchen Helper: An older toddler can “help” you in the kitchen. My daughter loved ripping the lettuce and making a salad each night. We told her how delicious the salad was and she beamed with pride. It was a full year before she decided to take a nibble of her handiwork!
4. Vitamins and Minerals: A picky eater may benefit from a multivitamin with minerals. Check with your doctor.
5. Nutrition Drinks: Some picky eaters may benefit from a nutrition drink made for children ages 1-12 years. It can be served as a substitute for a meal, added to a shake or smoothie or used in cooking instead of milk (i.e.: pudding pancakes).
6. Hide the Oreos: I kept my emergency chocolate supply on a high shelf. The “snack drawer” was full of healthy snacks within her reach: crackers, pretzels, raisins, nuts. That way, she was not tempted by unhealthy food choices.
7. Little Stomachs/Little Meals: Make sure you are offering small portions to your toddler. In the morning, she ate breakfast followed by her “fruit snack”. My picky eater ate half her lunch at noon and then in the afternoon, her “snack” consisted of the other half of her lunch. After dinner, if she was still hungry, it was time for her “yogurt snack”.
8. Play with your food: Make sure mealtime is enjoyable and playful. Bring out the special silverware and plates (with your child’s favorite character on it of course); invite a friend to join you. Eat in a new place: on a big rock, on the top of the jungle gym or in a kid friendly restaurant.

Remember, your picky eater will be a teenager before you know it and will surely eat you out of house and home! Good luck and happy eating!

©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.