More on which vitamins to choose

Here’s a question from Poornima: “Every time I go to a store I see more of the supplements for kids- there is the usual multivitamins, then there is calcium supplements, omega supplements, vitamin C etc, etc. Does a child need them all? I was looking for information on some of them- like one of the ads said that omega was for brain development, one of them was for immune boosting etc. So what should we give a child? At what age do we usually start giving them supplements?”

I answered a similar question here, but now’s a good time to expand on some of these issues, especially in light of a new AAP recommendation regarding vitamin D.

Vitamins are chemicals that are essential to human health that can’t be made in your own body (there are a few exceptions, more on those below*.) Generally, they have to be ingested frequently to keep up healthy levels. The amount of each vitamin that you need are very small, often only a few milligrams a day–but if you don’t get this, you’re in big trouble.

Ever since vitamins were first described, they’ve attracted a lot of special mysticism and quackery. Many patent medicines and snake-oil preparations have been made using vitamins, and all sorts of vitamin-based concoctions still line the shelves at CVS and health food stores alike. But just because your body needs a little bit of something doesn’t mean that a whole lot extra of something is going to do you any good. “Extra” vitamins are not in any way helpful, and in a few instances can actually have toxic effects.

Children in the Unites States are awash in vitamins. All grain products, milk, and salt are fortified, and most conditions of vitamin deficiency are very rarely seen. The few exceptions to this are vitamin D deficiency and iron deficiency.

Vitamin D deficiency arises because this vitamin doesn’t exist in a good, absorbable form in any common food (if you’re curious: it’s in some oily fish and the liver and fat of marine mammals.) Humans can make plenty of this vitamin by being outside, but in today’s world of indoor entertainment and fear of skin cancer, sunlight is avoided. The AAP recently updated their recommendation, and now says that essentially all children should get a supplement containing 400 IU of vitamin D—all children except those consuming more than 32 ounces a day of fortified milk or baby formula. That’s a lot of milk, and very few kids past babyhood are getting that much. 400 IU of vitamin D is found in one dropperful (1 ml) of just about any baby multivitamin, or in one child’s chewable vitamin (eg Flintstones, or a generic equivalent.) Getting adequate vitamin D not only helps promote strong bones, but may prevent many cancers and auto-immune diseases.

Iron is found in most meats, and is also in many fortified grains and cereals. Many children, especially those from socially disadvantaged backgrounds, do not get enough iron in their diets.

You also asked about omega-3 supplements, often taken in the form of “fish oil” capsules. Omega-3s are essential fatty acids that are important for brain and eye development, and may also help prevent strokes and cognitive decline in elderly people. We don’t know exactly how much omega-3 children (or adults) need to have for optimal health. Some children’s vitamins are starting to include omega-3s, or you can get these from fish-oil, flax-seed oil, or one variety of Gummy sources.

A good, well rounded diet including fish, whole grains, and fresh fruits and vegetables will help provide most of a child’s vitamin needs. But often this kind of diet is not easy to attain. With this in mind, it’s a good idea for all children to take a daily multivitamin with iron. Choose one that tastes good and is inexpensive, like a store brand. For babies, a liquid is available; or children from about age 2 can handle chewables. There is absolutely no advantage to expensive, fancy, designer, or name-brand vitamins.

Try not to get caught up in the hoopla in advertisements. Vitamins, for sure, are essential to good health, and lack of vitamin intake can lead to very serious diseases and death. But extra vitamins, or extra-expensive vitamins, aren’t going to do your child any extra good.

*Exceptions to the usual definition of “vitamin”: Vitamin D is made in your skin, and functions more like a hormone than a vitamin; still, the name “Vitamin D” has stuck. Vitamin K isn’t made by your own cells, but rather by microorganisms that live in your gut. The only people who need a vitamin K supplement under normal circumstances are newborn babies, who don’t have any gut bacteria yet.

For more about vitamins and the history of nutrition, including some fairly gruesome information about the historical impact of vitamin deficiencies and a detailed account of vitamins and quackery, read Terrors of the Table by Walter Gratzer.

Who needs more vitamin D?

A question from Allison: “I just read that 40% of children are thought to be vitamin D deficient. How can we figure out if our child falls into that 40%? Should we give vitamin D supplements just in case? What should we do to make sure they stay vitamin D healthy?”

The honest, insider answer to these excellent questions is: we don’t know. We don’t know how much vitamin D a child ought to ingest every day, and we don’t even know what the “normal” blood levels of vitamin D should be!