Posted tagged ‘Nutrition’

Should you buy vitamins from your friends?

September 3, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

Alison wrote in:

 

It seems like every time my (almost 6 year old) child gets sick, a line forms of sales-friends who try to convince me that ‘ever since they gave their child Juice Plus+, they haven’t been sick.’  Could you give your opinion from your medical perspective?  Personally, I prefer to give Flintstones vitamins with the iron, but I’d love to have a better understanding of the best vitamins to give.

 

Vitamins are an interesting psycho-sociological phenomenon. We know that we need them—if you don’t get any vitamin C, you’re fairly quickly going to suffer a fairly horrendous death—but we barely need much of any of them. Just a few milligrams, here and there, not even every day, will keep you and your children chugging along just fine. But, of course, being the creatures that we are, many people seem to view vitamins as having magical abilities. If a tiny bit is good, a whole lot more is better. Or, since some  vitamins are involved in energy metabolism, taking a whole lot of them will give you more energy. Or cure a hangover, or make you invulnerable to colds, the flu, and presidential debates. Magic!

The truth is, vitamins are just chemicals. Like any other chemical, once you swallow it your body doesn’t know or care if it came from a leaf or a pill; and it certainly doesn’t care if it came from a cheapo pill or an expensive, name-brand pill sold by one of your “sales-friends.” A vitamin is a vitamin. If you think your child needs one (and he probably doesn’t), take an inexpensive one and save up some money to buy more yummy fresh fruits and veggies. Because those, he could probably use. A pill that claims to be a replacement for real fruits and real veggies? Sold as part of a multilevel marketing scheme? Please.

What about vitamins for parents? Several good studies in adults show that people who regularly take multivitamins have poorer health. Makes you wonder about all of that vitamin marketing.

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A preschooler wants to be a vegetarian. And Simpson quotes!

August 20, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

 

Leslie wanted to know:

 

 Dr. Roy, do you have any advice about a preschooler who wants to be a vegetarian? A few days ago at a family party an older cousin decided to tell my four-year-old aspiring veterinarian, who loves animals so much she sobs if she accidentally steps on an ant, what her hamburger was made out of. She…did not react well to the information, and has since steadfastly refused to eat any type of meat. Thankfully she’s too young to know that veganism is a thing so she’ll still eat dairy products and eggs and such, just not meat, which I’ve always heard is a pretty important part of a growing child’s diet. Is it safe for a kid so young to *never* have meat? Should I get her on some special vitamins or supplements or make sure she eats plenty of certain other foods to make up for it? Or do I just need to put my foot down and insist that she eats whatever I make? All of the advice I’ve found so far basically boils down to that, but it seems like that would be so traumatizing and send her the message that I don’t care about how she feels or what she values. I just want to keep her healthy, physically AND emotionally, but I don’t know what to do!

 

This reminds me of a Simpsons episode…

 

Lisa: “I can’t eat this. I can’t eat a poor little lamb.” [pushes her plate away]

Homer: “Lisa, get a hold of yourself. This is lamb, not a lamb.”

Lisa: “What’s the difference between this lamb and the one that kissed me?”

Bart: “This one spent two hours in the broiler!” [takes a big bite]

 

From a nutritional point of view, meat is a great source of easily-digested protein and bioavailable iron. But, really, very few American kids have a problem with not getting enough protein in their diet. All dairy products are complete proteins, as are eggs and peanut butter and delicious bacon. I mean tofu.

 

Homer: “Lisa, honey, are you saying you’re never going to eat any animal again? What about bacon?”

Lisa: “No.”

Homer: “Ham?”

Lisa: “No.”

Homer: “Pork chops?”

Lisa: “Dad! Those all come from the same animal!”

Homer[chuckling] “Yeah, right, Lisa. A wonderful, magical animal.”

 

Iron, though—iron might be another story. Iron can be found in some vegetables, especially those dark leafy green ones that Lisa loves, and beans and grains. But that kind, called non-heme iron, isn’t easily absorbed. The heme iron found in meat and seafood really does get into your body better. Absorption of non-heme iron can be increased by consuming foods with vitamin C (like citrus fruits), eating your non-heme iron with a little meat (not Lisa’s first choice), or cooking with a cast-iron pot. If none of that is practical, it’s easy enough to get an iron supplement to replace the iron in meat.

 

Lisa: “Uh, excuse me? Isn’t there anything here that doesn’t have meat in it?”

Lunchlady Doris: “Possibly the meat loaf.”

Lisa: “Well, I believe you’re required to provide a vegetarian alternative.”

[Doris picks up a hot dog, shakes the wiener out, and slaps the bun down on Lisa’s tray]

Doris: “Yum. It’s rich in bunly goodness.”

Lisa[dryly] “Do you remember when you lost your passion for this work?”

 

I’m assuming, here, that the child is willing to continue eating dairy products—without those, it’s difficult to get enough calcium and vitamin D. I think a family can easily follow a lacto-ovo vegetarian diet (including dairy and eggs) without much worry, and in fact such a diet is almost certainly more healthful than that of many families. But strict veganism, with no eggs and no dairy, is tricky, especially with younger children. I suggest any family who’s raising vegan kids spend some face-to-face time with a registered dietician (NOT a “nutritionist”! Don’t get me started on nutritionists.) That way they can learn what they need to know to ensure an adequate diet and correct use of supplements. It can be done, but it requires some work and planning.

 

Paul McCartney: “Linda and I both feel strongly about animal rights. In fact, if you play ‘Maybe I’m Amazed’ backwards, you’ll hear a recipe for a really ripping lentil soup.”

Lisa: “When will all those fools learn that you can be perfectly healthy simply eating vegetables, fruits, grains and cheese?”

Apu: “Oh, cheese!”

Lisa: “You don’t eat cheese, Apu?”

Apu: “No, I don’t eat any food that comes from an animal.”

Lisa: “Oh, then you must think I’m a monster!”

Apu: “Yes, indeed, I do think that.”

 

Leslie asked if she should just put her foot down, to force her daughter to eat meat. I don’t think that’s the way to go. I can respect her daughter’s wish to not harm animals, and she can have a perfectly healthful diet that fits her own moral philosophy. Yes, even four year olds can and should have a sense of right and wrong, and I’m not so sure we meat eaters are in fact morally superior to a vegetarian preschooler. Or Lisa Simpson.

Selling to children

September 7, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

At the Pediatric Insider, I try to illustrate how people think: how doctors think about health and illness, and how parents think about raising their kids. Sometimes, our own experiences and preconceptions can fool us. That’s why adults seem to think expensive placebos are more effective, and why some well-meaning parents refuse vaccines despite overwhelming evidence of their safety and effectiveness. The internet has, of course, amplified the effects of misinformation and innuendo. It has also created a way for real-but-crazy stories to seem more close-to-home. We’re being bombarded by messages that subvert and influence our thinking in very creepy ways.

Fortunately, our children are immune to this kind of hanky-panky. Right?

In a July 2010 study titled “Influence of Licensed Characters on Children’s Taste and Snack Preferences,” researchers created a simple protocol to see if a smiling, familiar cartoon face changed the perceived tastiness of three common foods. They prepared pairs of bags of graham crackers, gummy fruit snacks, and baby-cut carrots, each labeled in clear packaging. The only difference was that one of each pair included a sticker with a cartoon character (Shrek, Dora, or Scooby Doo.) Each of the 40 children in the study were presented with a pair and asked to take a single bite of each food. Afterwards, they were asked if the two tasted the same, and if not, which one tasted better. Keep in mind that the pairs of food were exactly the same in every way, including the packaging and presentation—except for the cartoon sticker on one of the two bags.

You can guess what happened.

About a third of the kids correctly answered that the foods tasted the same (or said “I don’t know.”) Of the children who perceived a difference, 70-90 % preferred the foods with the licensed characters.

This should surprise no one. Look around the grocery store, especially at breakfast cereals and “snack foods” and other items sold at a child’s eye level. They’re festooned with popular characters exhorting children to buy, buy, buy and eat, eat, eat!

Of course, there’s a silver lining here. Maybe parents ought to buy a strip of Dora stickers to slap on the carrots when Junior’s not looking. When the going gets tough, the tough get sneaky!



Refusing milk from a cup

November 24, 2009

The Pediatric Insider

© 2009 Roy Benaroch, MD

 

Analise is trying to get her daughter to continue drinking milk: “My daughter is 14 months old and will only drink milk from a bottle. We introduced a sippy cup at 9 months but made the mistake of only putting water in it. Now she associates the cup with water and the bottle with milk. We’re in the process of weaning her from the bottle but don’t know how to convince her to drink milk from a cup. Do you have any tips or is it just try, try again until she accepts it? Thanks for any behavioral insight or advice!”

 

First, let me get myself in trouble with the dairy council and moms everywhere by letting this secret out: there is no essential need for toddlers to drink milk. It’s a good source of protein and calcium, sure, but there are plenty of other good sources. Lots of children stop drinking milk, and many adults never touch the stuff. There’s no reason to consider milk something crucial for children to drink once they’re outside of the young baby years and able to take solids well.

 

At fourteen months, whether or not your child is willing to drink milk from a cup, you ought to stop using baby bottles. They’re bad for her teeth, and they’re preventing her from developing normal eating habits. Don’t worry that your child won’t get enough fluids—she’ll drink water, and she will not become dehydrated without milk.

 

Though milk isn’t essential, it’s handy and most children continue to drink it. There are, of course, tricks worth trying to get her to drink milk from a cup:

 

  • Add a little milk to the water in a cup, and day-by-day start adding more milk and less water. In a few weeks, you can wean up to full strength milk. Do this gradually and maybe she won’t notice.
  • Add something to the milk to make it extra tasty: chocolate syrup, or maybe a mashed-up, very soft banana. Little girls (and boys) deserve a little chocolate in their lives.
  • Try a different sort of cup, like one with a straw—maybe even a crazy bendy cool straw.
  • Make sure she sees you and dad drinking milk from a cup. You two can even use sippy cups for a little while. If parents don’t drink milk, children are far less likely to want it.
  • If you’ve been using whole milk, give 2% or skim a try. Older advice did recommended whole milk, but that’s not necessary.
  • Try a different sort of milk, like soy or almond milk. These provide similar amounts of protein and calcium as cow’s milk. Rice milk, on the other hand, is a low-protein beverage more similar to juice than milk—stay away from it if you’re looking for something with nutritional value for your children.

 

What to do during the transition? Don’t worry about it. There is no reason a child can’t go weeks or months or even years without milk. If your daughter gets the impression that milk is something very special and important, she’s less likely to touch the stuff—this is called “yanking your parents’ chain,” a skill that all children learn sooner or later. Don’t get caught up in the drama by letting her know you’re worried about this. Win the chain-yanking match by dropping your end.

 

If in the long run your daughter still won’t touch milk, you’ll need some other good calcium sources:

 

  • Any other dairy: cottage cheese, yogurt, cheese, ice cream
  • Calcium fortified juices
  • Calcium supplements, like the little chocolate squares marketed for women as Viactive
  • Non fat dry milk powder. Don’t mix this in water to try to drink it—blecch—but sprinkle it in casseroles, soups, eggs, sauces, that kind of thing. Once it mixes in it’s just about impossible to taste. Think of it as cheap calcium –n- protein powder.

 

Try some simple tricks to see if you can get your daughter back on milk, but remember there is no hurry here, and this is not a crucial or even a very important issue. Milk is easy and cheap, but there are many other nutritious things your daughter can take that can replace milk if she’s decided she just won’t drink it any more.

Pleased to meat you

October 19, 2009

The Pediatric Insider © 2009 Roy Benaroch, MD

 Isabelle posted, “I know this is a complex question but ideally how many times a week do young children need red meat. (my child is 2). My parents are vegetarians so every time I am around then I get parental guilt that I am feeding my son too much red meat. He is honestly only getting 2 servings a week at home (a bit more at daycare) Any guidance?”

Meat is a good source of protein and iron, but isn’t in any way essential for good health– as long as your son is getting protein and iron from somewhere else.

A toddler needs about 10 mg a day of elemental iron. He can get this from any combination of these sources*:

  • Iron-fortified cereal, 1/2 cup: 3-9 mg 
  • Red meat, per 3 oz serving: 2-3 mg
  • Kidney Beans, 1/2 cup: 2.5 mg
  • Enriched rice, 1/2 cup: 1.5 mg
  • Whole wheat bread, 1 slice: 1 mg
  • Egg, one: 1 mg
  • Pretzels, 1 oz: 1 mg

Eating something that includes vitamin C at the same meal will help get ingested iron into the body, especially iron from plant sources. 

Meat is also a good source of complete and easily-digested protein, but there are plenty of other sources of protein in a typical American diet. A toddler needs about 16 mg of protein each day, which is readily available from many sources. Any single one of the following items will provide all of the protein a toddler needs in a day:

  • 1/3 cup chicken
  • 1/2 of a fast food taco
  • 1/2 cup of cottage cheese
  • 3 oz of salmon
  • 1 cup of beans
  • 4 tablespoons of peanut better
  • 2 oz nuts
  • 2 eggs
  • Milk, 2%, 2 cups

So: meat’s a handy way to get iron and protein, but it’s hardly the only way. You don’t need to feel guilty about not eating red meat much. Your vegetarian parents can certainly good nutrition for your son when he visits, though if they’re really strict vegans (no eggs, no dairy, no food derived from animals in any way) it may take some more work to ensure adequate iron, protein, vitamin D, and vitamin B-12. I wouldn’t even worry about that unless he spends most of his time at their place.

* I rounded off nutrition information based on the US Department of Agriculture’s searchable database of nutrition information. It’s reliable and very complete, and it’s free of the ads and odd misinformation that seems to pervade many “nutrition” sites.

More on which vitamins to choose

November 22, 2008

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.

Mmmmm…eggs!

November 20, 2008

Mark wants to know: “How many eggs can a child eat each day? Is there some kind of guideline about this?”

As far as I know, there is no established guideline on how many eggs children should eat. A few years ago egg consumption was discouraged for adults, because they do contain a lot of cholesterol. Since then it’s become more clear that it isn’t the cholesterol you eat that ends up in your blood, but rather the saturated fats and especially trans fats that cause increased “bad cholesterol.” So perhaps eggs got a bit of a bad rap, back there.

As an aside: dietary guidelines to reduce blood cholesterol in the 1990’s were over-simplified and woefully misguided. They discouraged all fats and eggs. It turns out that some fats can lower cholesterol (mono-unsaturated fats like olive oil and canola), and that actually not all kinds of cholesterol are bad for you (HDL-cholesterol prevents heart attacks!) The best dietary advice to help reduce your risk of coronary artery disease is to avoid saturated fats (usually, this means fats from animal sources) and avoid trans-fats (things that include the phrase “partially hydrogenated”, usually processed foods).

Eggs are cheap, and a great source of calories, protein, and iron. They’re easy to make a bunch of different ways (see below!), and if your child likes ‘em, I say let him enjoy.

Roy’s French Toast Sticks, with Special Dippin’ Sauce

Cut up challah bread into stick shapes, and soak them in scrambled eggs. If you scramble the eggs with a stick-blender, they soak into the bread more evenly and you don’t end up with trailing brown stringy ends that make kids turn up their noses. Fry ‘em up on all sides, rotating every few minutes, until tasty.

Special dippin’ sauce: melt a stick of butter in the microwave, and then add a good squirt of maple syrup. Stir in a little vanilla extract, a teeny pinch of salt, and maybe a dash of cinnamon. Whip it together with a fork.

Rocky Mountain Eggs

Take a slice of wheat bread, and tear out a circle in the middle, about 2 inches across. Eat the bread circle (it’s bad luck if you don’t, I’m told.) Melt butter in a non-stick fry pan, then fry the bread on one side. Flip it over, and crack an egg in the hole. Let it set for a few minutes, then flip it and cook on both sides back and forth for a total of maybe 5 more minutes.