January 2008
Supplements:
Nutrition Insurance For Children
By Kindy R. Peaslee, RD
Today’s Dietitian
Vol. 10 No. 1 P. 50
In today’s era of soil depletion and
processed foods, parents are wise to look into a nutritional
protection plan for their kids—perhaps one that consists
of a high-quality food-based supplement.
In an ideal world, our children would get enough
nutrients from the food they eat. Of course, as dietitians,
we know that is not always the case. Theoretically, a balanced
diet would give our children all of the necessary vitamins and
minerals. But many of the foods families eat are processed and
have very few nutrients. As food and nutrition professionals,
we know that the nutrients we require should come through our
food supply; yet cooking, storage practices, our toxic environment,
and soils depleted of essential nutrients cause food to be stripped
of its natural nutritional content.
In addition to this, the sad reality for numerous
children is that they prefer processed food. As a result, even
if local and organic whole food is purchased, it’s practically
impossible to get adequate amounts of vitamins and minerals
from food alone, and our children will not always eat these
food choices.
Don Colbert, MD, author of The Seven
Pillars of Health, believes that supplements are
essential for maintaining good child health. On the premise
that our children do need supplements, he recommends whole food-based
nutrients that combine enzymes, vitamins, antioxidants, phytochemicals,
and minerals to work together synergistically.
Wendy Howard, RD, LD, pediatric nutrition specialist,
agrees and recommends only whole food supplementation to the
patients she counsels at her private nutrition practice in Texas.
“The advantage of whole food nutrients compared with isolated,
fragmented nutrients opens up a whole new perspective on supplementation,”
says Howard. She shares the prevention message with her clients
by educating them on the difference between a vitamin/mineral
pill, which may contain 10 or 20 isolated nutrients, and a whole
food supplement containing real food nutrients such as fruits,
vegetables, and grains, which will provide tens of thousands
of phytochemicals. Colbert points out that if children are eating
a healthy diet, they should be getting at least 50% of their
daily vitamins and minerals from the foods they eat. “Remember:
Supplements are just that and should be in addition to the nutrients
obtained from a healthy diet,” he says.
Natural vs. Synthetic
Supplements
What is the best form of supplementation? Is the bioavailability
of whole food vitamins better than synthetic vitamins? In The
Real Truth About Vitamins and Antioxidants, author
Judith De Cava promotes the choice of natural food concentrates
when using supplements. She says this does not necessarily mean
that synthetic vitamins are useless. “Natural food concentrates
have a much lower ‘potency’ in milligrams or micrograms,
which leads many consumers to believe that they are less effective
and not as powerful as synthetic vitamins,” DeCava says.
“Yet food concentrates cause potent nutritional reactions
as they are working synergistically in the body.”
De Cava also points out in her book that a minute
amount of a vitamin left intact in its whole food form is tremendously
more functional, powerful, and effective nutritionally than
a large amount of a chemically pure vitamin fraction. She concludes
that only small amounts of natural vitamin complexes and organic
micronutrients are required to accomplish many “big biochemical
jobs.”
Backing up De Cava’s research are two
separate studies on the body’s actual micronutrient absorption
of dried, encapsulated fruit and vegetable preparations and
how effectively the body is able to use the nutrients. Study
results showed increased plasma levels of select antioxidants
with positive micronutrient absorption by the body.1 Research
findings also indicated the bioavailability of phytochemicals
from the food-based supplements.2
Veiw Supplement
Chart Here.
When to Start Giving
a Multivitamin
William Sears, MD, who has practiced pediatric medicine for
more than 30 years, believes children need more vitamins, minerals,
and other nutrients per pound of body weight than adults. He
feels that because of their erratic eating patterns and lack
of wholesome food consumption, children are more likely to have
nutrient deficiencies. Sears advises parents on his Web site—www.askdrsears.com—to
consider the child’s age and stage before administering
supplements. He has found that the best time to start giving
a supplement is when the child enters an erratic eating stage—usually
in the toddler or preschool years. To be on the safe side, he
recommends parents start their children on a supplement between
the ages of 1 and 2, since they are more prone to nutrient deficiencies
and tend to be picky eaters during this stage.
However, Sears advocates feeding children healthy
food rather than giving them pills, as he believes it is best
to get vitamins and minerals through food due to nutrient synergy.
“Make sure the multivitamin you choose contains the ‘big
six’: omega-3 fats, calcium, iron, zinc, vitamin C, and
vitamin E. These are the nutrients most often deficient in children,”
he says. Sears asks parents to consider giving their child supplemental
omega-3s. He has seen that the most common nutrient deficiency
in growing children is omega-3 fats, noting that most over-the-counter
multivitamin/mineral preparations don’t contain them.
Supplement Use by Children
The American Academy of Pediatrics (AAP) states that “a
diet based on the Food Guide Pyramid provides adequate amounts
of all the vitamins a child needs.” Although advocating
a healthy diet first and foremost, the AAP does feel there are
situations where vitamins are necessary, especially if the child
is a very picky eater or has a poor diet. The AAP acknowledges
that a daily dose of children’s vitamins recommended by
a pediatrician could be helpful and add to the many fortified
foods now available.
According to the AAP, 20% of children do not
get enough vitamin D. Based on this finding, the AAP has started
recommending vitamin D supplementation for infants and children.
Because breast milk is a poor source of vitamin D, exclusively
breast-fed babies should receive 200 to 400 international units
of vitamin D daily as recommended by a pediatrician. Older children
who don’t drink at least 17 ounces of vitamin D-fortified
milk also need supplements if they don’t get regular sunlight
exposure.
New research on supplement use by children surprised
researchers at the National Institutes of Health with results
showing that only 32% of American children take dietary supplements.3
The study, as reported in the Archives of Pediatrics
& Adolescent Medicine, was based on a national
survey conducted from 1999 to 2002 that included 10,136 children
aged 18 or younger. The most commonly used supplements were
multivitamins and multiminerals, which were taken by 18% of
the children. Only 4% used single-vitamin supplements and 2%
used single-mineral supplements, with less than 1% using botanical
supplements.
Mary Frances Picciano, PhD, who led the study,
says the researchers anticipated that supplement usage would
be higher among children than adults, but the opposite was true.
The research also revealed that children using supplements were
more likely to be thinner; to be from a higher-income, nonsmoking
family; and to spend less time watching television and playing
video games. The study found that non-Hispanic white children
were nearly twice as likely as black children to take supplements.
When it came to age groups, the most likely to be taking a dietary
supplement were those aged 4 to 8, followed by 1 to 3, 9 to
13, 14 to 18, and infants younger than the age of 1.
A study in the Journal of Orthomolecular
Medicine showed how vitamin C supplementation
helped to protect children from heavy metal absorption and improve
behaviors.4 Erik Paterson, MD, has seen a dramatic increase
in behavioral problems, learning disabilities, attention-deficit/hyperactivity
disorder, and autism among children. He notes that the number
of children receiving special education services continues to
rise. Growing evidence suggests that heavy metal pollution is
a contributing factor, and vitamin C supplementation may be
part of the solution. Paterson, with experience as a consulting
physician at a center for the mentally challenged, researched
high blood lead levels responding to equally high doses of vitamin
C administered (up to 4,000 milligrams per day). After following
lead levels over a two-year period, Paterson saw lead levels
drop and become practically undetectable with marked behavior
improvement in the patient.
University of Victoria professor Harold D. Foster,
PhD, believes that in addition to vitamin C, selenium may also
protect children by helping to eliminate heavy metals from their
bodies. Based on the study’s results, Foster recommends
children take a vitamin C supplement with each meal, along with
a multivitamin containing selenium.5
Confirming that supplement use does make a difference
in children’s behaviors, the Children’s Health Study
conducted questionnaire surveys with more than 25,000 children
aged 6 to 15 to determine what effect adding food-based supplements
to the family diet can have on children’s health. The
study measured behaviors such as how many days of school children
missed and how many times they visited the doctor. Parents reported
that after four to eight months of their children taking the
supplement, 46% of the children had been to the doctor less
often, 39% reported missing less school, 41% were taking less
over-the-counter medication and/or prescription drugs, 58% were
drinking more water, 61% were consuming less soft drinks or
fast food, and 43% were eating more fruits and vegetables.
Hints for Compliance
Once they understand that supplements can greatly enhance their
children’s diets, parents need guidance on how to get
their children to be consistent with taking vitamins. It is
unreasonable to expect a small child to swallow a tablet or
piece of a tablet. Instead, parents need to choose a food or
drink that hides the vitamin taste, crush the tablet to powder
form, and mix it into a favorite juice or soft food. “Applesauce
or sugar-free jelly works well when mixing the crushed tablet
or powder,” says Mary Ann Colegrove, an Ohio-based RD
and mother of two young boys. She reports that the above method
has worked well with her sons, who take their supplements faithfully.
Liquid vitamin preparations do not keep well
after opening and quickly lose their potency, even in the refrigerator.
Vitamin tablets or capsules should not be kept in a refrigerator.
The package may say store in a cool, dry place, but the refrigerator
is a cold, wet place. Moisture generally reduces supplement
potency. Keep bottles out of the sun and off the stove. Once
children are old enough to handle chewable tablets, parents
should consider chewable supplements, which are tasty and convenient.
However, beware of artificial colors, flavors, and sweeteners
in the ingredient list. The best way to administer supplements
to a child is to establish an enjoyable routine at home on a
consistent basis. If supplements can’t be given at home,
most schools require a letter from a doctor giving a child permission
to take them at school.
Parents continue to be bombarded with complicated
health choices for their children. As dietitians, we can help
parents sort through the many brands of “cookie-cutter”
children’s vitamins. Mary Beth McCue, RD, LDN, CDN, an
integrative nutrition consultant from upstate New York, specializes
in developing individualized nutrition programs involving supplementation.
She promotes whole food supplementation for children because
she believes the body is able to utilize the nutrients more
effectively. “Since children require a comprehensive mix
of nutrients during phases of growth and development, they are
establishing a healthy foundation in their bodies, which will
set the stage for a lifetime of health,” says McCue. “Children
face more challenges today in the lifestyle areas of increasing
stress, maintaining healthy immune systems, and eating a diet
of whole, sustainable foods.”
Dietitians have an opportunity to invest in
the future of wellness by educating parents and children about
the best food-based supplements available. Let’s follow
Howard and McCue’s lead and recommend the use of high-quality
whole food and/or phytonutrient supplements for children. Unfortunately,
much of the vitamin industry is still a business filled with
fraud and confusion for the consumer. As the nutrition experts,
we can help parents by recommending the best-quality, synergistic
mix of nutrient compounds for their children. In other words,
we can provide “nutrition insurance” for the next
generation.
— Kindy R. Peaslee, RD, is the founder
of Kindy Creek Promotions, an upstate New York-based marketing
firm specializing in the promotion of natural and organic food
and beverage products. She can be reached at kindy@kindycreek.com.
Visit her recipe Web site for parents: www.healthy-kid-recipes.com.
References
1. Leeds AR, Ferris EAE, Staley J, et al. Availability of micronutrients
from dried, encapsulated fruit and vegetable preparations: A
study in healthy volunteers. J Hum Nutri Diet.
2000;13(1):21-27.
2. Wise JA, Morin R, Sanderson R, et al. Changes
in plasma carotenoid, alpha-tocopherol, and lipid peroxide levels
in response to supplementation with concentrated fruit and vegetable
extracts: A pilot study. Curr Ther Res.
1996;57(6):445-461.
3. Picciano MF, Dwyer JT, Radimer KL, et al.
Dietary supplement use among infants, children, and adolescents
in the United States, 1999-2002. Arch Pediatr Adolesc
Med. 2007;161(10):978-985.
4. Orthomolecular Medicine News Service. Vitamin
supplements help protect children from heavy metals, reduce
behavioral disorders. October 8, 2007. Available here.
5. Gajawat S, Sancheti G, Goyal PK. Vitamin
C against concomitant exposure to heavy metal and radiation:
a study on variations in hepatic cellular counts. Asian
J Exp Sci. 2005;19(2):53-58.
Chart: Natural
vs. Synthetic Supplements
