Archive for the 'Vitamins' Category

Building Strong Bones Now and for the Future

Those of you who have seen me over the years in clinic have heard me say that my advice on the need for vitamins has changed over time. This is especially true when it comes to vitamin D, which I’ve learned can make a significant difference in building bone strength for both kids and adults.

Those of us living in the Northwest do not see the sun often enough to make enough vitamin D, and thus need to supplement. The problem here is that although the sun helps our bodies make vitamin D, we just don’t see that yellow ball in the sky for nine months of the year. When it is out in the summer, you should be applying sunscreen, which protects you from the sun but unfortunately decreases your natural vitamin D production at the same time.

Most children and adults with a typical healthy diet will take in adequate amounts of the other nutrients, but with vitamin D, it’s challenging. In 2010, the Institute of Medicine increased the recommended dose of vitamin D to 600 IU for all people who are more than 12 months in age. This is up from the prior recommended dose of 200 IU. A glass of milk or fortified orange juice has about 100 IU per serving. We typically do not recommend children drink more than 2 glasses of milk a day. Cheese does not have vitamin D. Things like yogurt contain only about 40 IU per serving. Herring has about 1300 units for a small serving, but I doubt you will get your child to eat it on a regular basis. Salmon and Halibut are fantastic sources with a small serving getting us very close to our daily need but it is too costly for most households to eat on a regular basis. That leaves us with the need to supplement.

Vitamin D is important for healthy bone strength as it plays a role in calcium and phosphate regulation. This is where there is the best evidence for its benefits. It’s a fat-soluble vitamin, which means that your body stores it and thus it’s possible to get too much if excess doses are taken for a prolonged period of time, causing symptoms such as irritability, muscle weakness, elevated blood pressure or kidney stones. It’s the in-vogue vitamin these days and gets mentioned for other indications such as prevention of multiple sclerosis, cancer, and heart disease, but the evidence thus far is not as strong. More studies are necessary to really tease this out. Time will tell if it lives up to the hype, but at least we can encourage strong bones in future by getting an adequate amount now.

Do Kids Need Milk?

Milk (we’re talking of the cow variety right now) has long been held up as a super food for kids. It’s in the news, as new regulations from the United States Department of Agriculture are eliminating flavored milks for kids at school as reimbursable options. This ruling is part of the Healthy Hunger-Free Kids Act that aligns school meal offerings with the 2010 Dietary Guidelines for Americans. There is some controversy surrounding this choice, which, on the positive side, has clearly been made with the prevalence of childhood obesity in mind. Will the decision lead kids to drink unsweetened milks, or make sugary drinks like juices more appealing? It remains to be seen, but not likely to change, at least in my practice, are the numbers of questions I get from parents about milk in general. I thought I’d share some of these inquiries along with the answers I commonly give to parents:

How much milk do kids need, if any?
It seems that many parents worry that their children don’t drink enough milk. It’s a topic I discuss at nearly every toddler well visit. I am not sure where this worry comes from. Kids can begin drinking cow’s milk around 12 months of age, and it’s a great way to get calcium and vitamin D, but not the only way. Toddlers don’t really need more than 16 ounces of milk a day. I’m more concerned about the child who drinks too much milk than too little, as there are so many other ways to get calcium ranging from soy and tofu to cheese and yogurt not to mention green leafy vegetables, such as kale. Children need about three foods that include calcium a day. If a child drinks too much milk they are getting unnecessary calories and tend to fill up on this and eat less of other nutritious foods.

Is milk the super food it’s always made out to be?
It’s good, as mentioned, but not the be all end all. Milk does not contain enough vitamin E, iron, and essential fatty acids. It also contains too much protein, sodium, and potassium. So make sure you’re providing a wide range of healthy foods for kids including fruits and/or vegetables and lean protein. Some people choose to go with goat’s milk for their families, by the way, which may be more easily digested by the body and has a different mineral content, as an alternative.

Whole or low fat?
When it comes to whole milk or low fat, the recommendation has changed. Obesity is a big issue in this country. To combat this problem, we now recommend low-fat milk if the child is going to be consuming other foods that contain fat. Basically, children need fat in their diet but most children get more than enough from other foods. Yogurt can be started around 7-8 months.

Flavored or unflavored?
In a perfect world, children would drink unflavored milk to avoid the unnecessary calories, but as we all know, the world is not perfect. Parents need to set boundaries and limits around what is acceptable to them either way, and stick to those limits.

Veggies: Fighting the Fear Factor

turnipsWhat is it about vegetables that makes many children protest at the sight of them and refuse to even take a nibble? I have a few patients who are so afraid of the color green, their aversion includes green fruits such as grapes or apples. I always wonder how much of this fear and disgust is real, and how much is  due to kids trying to gain some control as their parents attempt to encourage healthy eating. But this is one battle worth fighting. The benefits are great, and if you get creative, the struggle may not be as hard as you think.

In our household, my kids’ vegetable consumption tends to wax and wane like the moon, with some weeks being better than others. Our household rule is that you either need to eat lots of different fruits or lots of different vegetables.  Raw seems to go over better as well. From a child’s perspective, it seems that the more you cook something, the more it tastes like vegetables.

I would love to say that we grow our own produce, which is an excellent idea to get the kids involved and increase the chances of them eating their greens (reds and purples too),  but we went the vegetable-box route with a local company. Every other week we get our veggie box and try to unpack it together so our kids can see the huge variety. Questions always arise when there’s something new. Buying from the farm has also gotten us to try new things that typically we would never think to grab at the grocery store. It can make healthy eating fun and exciting for my kids.

Many families grow their own produce. This is such a wonderful way to get the children involved and teach them about gardening. Kids may be more interested in eating the vegetables they plant themselves or see sprouting close to home. They can participate in the full growing cycle that begins with preparation of the soil and planting of the seeds and ends with the harvesting of the crops. Home gardening can also lead to conversations on the important role insects can play in our environment.

Perhaps what may be most worthwhile, gardening allows families to get outdoors and engage in an activity together, which can only help the family grow closer.

When Disaster Strikes

Certainly there is a lot going on in the world right now and it is impossible for our children to not hear about disasters that are occurring. Haiti is just a recent example.

Depending on the age, it is very appropriate to limit children’s exposure to graphic images of disaster victim’s devastation that are all over the news right now. This can be quite overwhelming to a child and needs to be done with care. Continue reading ‘When Disaster Strikes’

Thimerosal and Vaccines

Since the recent announcement that Washington State is lifting the ban on thimerosal in order to vaccinate children against influenza H1N1 otherwise known as swine flu, I have been asked many questions on this topic.

The ultimate question is “is the vaccine safe” and “what about thimerosal”? The quick answer is that getting the H1N1 vaccine is important. The scientific literature does not support an association between thimerosal and autism. When the vaccine becomes available, I have no concerns about my children getting whatever form of the vaccine is available.

Some background on Thimerosal from the CDC and FDA websites. Thimerosal is a mercury-containing preservative used in some vaccines and other products since the 1930s. There is no convincing scientific evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site. However, in July 1999, the Public Health Service agencies, the American Academyof Pediatrics, and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.

Thimerosal, which is approximately 50% mercury by weight, has been one of the most widely used preservatives in vaccines. It is metabolized or degraded to ethylmercury and thiosalicylate. Ethylmercury is an organomercurial that should be distinguished from methylmercury, a related substance that has been the focus of considerable study.

Evidence from several studies examining trends in vaccine use and changes in autism frequency does not support such an association. Furthermore, a scientific review* by the Institute of Medicine (IOM) concluded that “the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.” CDC supports the IOM conclusion.

The above is from the FDA website

D is for Deficient?

Is your child getting enough Vitamin D?

Vitamin D is important for bone growth and preventing osteoporosis later in life. In the last few years it has become clear that more and more kids are Vitamin D deficient. A recent study published in the magazine Pediatrics showed that nine percent of U.S. children are vitamin D deficient and another 61 percent have insufficient levels. The solution here is not to do a blood test but to ensure that your child is getting adequate intake of vitamin D.

Why We Need the D

Vitamin D is important to bone growth because it makes it possible to absorb calcium. The studies also showed that children lacking the “sunshine vitamin” were also more likely to have high blood pressure and lower levels of lipoprotein (the “good cholesterol”) which can be risk factors for heart disease later in life.

The current recommended daily allowance of Vitamin D for children is 400 IUs (international units) a day. Previously it was thought that 200 IUs were enough. It’s also important that your child doesn’t get a very excessive amount of it because Vitamin D is fat soluble, meaning it is stored in the fat where it stays for longer periods of time, posing a risk for toxicity. Potential side effects from too much Vitamin D include nausea, vomiting, nervousness, weakness, high blood pressure and even kidney stones.

Where We Get D

Vitamin D comes naturally from two sources: certain foods and sun exposure. There’s some thought that we are lacking in Vitamin D due to increased time spent indoors as well as the use of sunscreen.

Many families can’t get enough Vitamin D through their diet. That’s of course assuming your children, like mine, don’t eat lots of herring (high in D with 1383 IUs for three ounces). If your child drinks two glasses of milk a day, then or she is getting about 200 IUs. Other dairy items such as cheese and most yogurts typically do not contain D although I am seeing more brands advertising this recently. Other foods high in Vitamin D are not necessarily “kid friendly”: shitake mushrooms, mackerel and sardines are not found in many lunch boxes.

To receive adequate Vitamin D from sunshine, your child needs to go outside in the sun with enough skin exposed for about ten minutes, several times a week. However as we know, even in the summer, sunlight is unpredictable. And as we enter into the darker days of fall and winter, sunlight will be even scarcer. There is also the concern of direct sunlight exposure without sunscreen leading to skin cancer later in life.

What to Do

Because getting adequate D naturally is difficult, it makes perfect sense to give your child a supplement. Shop carefully though, many children’s vitamins do not have enough D. Again, the current recommendation is 400 IUs a day.

You can also offer your child foods fortified with Vitamin D. Many food manufacturers are taking advantage of heightened awareness of Vitamin D and are now marketing Vitamin D fortified products.

Though please remember that supplements can never take the place of an overall healthy lifestyle.

Natural food sources and IU per serving

  • Herring 1383 per 3 ounces
  • Herring, pickled 578 per 3 ounces
  • Salmon, pink, canned 530 per 3 ounces
  • Halibut 510 per 3 ounces
  • Mackerel, Atlantic 306 per 3 ounces
  • Shitake mushrooms, dried 249 per 4
  • Tuna, light meat, canned in oil 200 per 3 ounces
  • Egg, cooked 26 per whole egg; 25 per yolk

Fortified sources and IU per serving

  • Tofu, fortified 120 per 1/5 block
  • Cow’s milk, all types 100 per 8 ounces
  • Rice milk, fortified 100 per 8 ounces
  • Soy milk, fortified 100 per 8 ounces
  • Orange juice, fortified 100 per 8 ounces
  • Pudding, made with fortified milk 50 per 1/2 cup
  • Cereal, fortified 40 per serving
  • Yogurt, fortified (such as Danimals) 40 per 1/2 cup

    Vitamin use in children

    I found this article interesting.  About a third of children take vitamin supplements. Although they are most likely harmless at normal dosing, most healthy children probably do not need them.

    Related to this, the American Academy of Pediatrics has changed the recommendation for Vitamin D to 400 units.  Many children do not get enough from milk intake and sunlight and thus, supplementation may be necessary.

    Here is the link to the recent article.