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Getting Enough of the Sunshine Vitamin

By Alan Greene, MD, FAAP

The American Academy of Pediatrics recently doubled their recommended daily amount of vitamin D for our kids – and many kids weren’t getting enough even before this change. The more closely we look at vitamin D, the more we learn about how important this sunshine vitamin is to both short- and long-term health for children. I’m happy to see the new level at 400 IU.

A preliminary study presented at the 2008 annual meeting of the American Academy of Allergy, Asthma, and Immunology found that children with low levels of vitamin D have a higher chance of respiratory problems. The results support other research that looks at how vitamin D might help support better respiratory health. Other studies suggest that adequate vitamin D helps maintain health for many body systems.

But parents are going to have to work a little harder to meet these new levels, as it has become more difficult to get enough vitamin D in recent years. Kids are consuming less vitamin D-rich foods such as tuna and vitamin D-fortified milk (in favor of sweetened drinks with less nutrition). A study released in 2008 showed that forty percent of healthy babies and toddlers were not getting enough vitamin D – and an earlier report said the same about American teens.

Kids get their vitamin D from three sources: the sun, food, and supplements. Getting the sunshine vitamin from the sun itself was the primary way through most of human history, when most of us spent most of our days outdoors. Today, even when we are outside, the (wise) use of sunscreen blocks the UVB rays that trigger vitamin D production. During the winter months, winter clothing restricts sun exposure even more. Plus, in the winter, the decrease in daylight hours and the change in the angle of the sun’s rays make it more difficult.

How much sun exposure does it take to get the vitamin D you need to thrive? The answer depends on your skin color, clothing, location, time of year, and time of day. Because of the angle of the sun’s rays, kids only make significant vitamin D after 10 am and before 3 pm in most of the US -- the hours that kids may be in school or daycare.

During the middle of the day, the amount of sunshine needed is a fraction of something called the minimal erythema dose (MED) – or the amount of sunshine it would take for the skin to turn slightly pink. In Florida at noon in the summer, the MED might be 4 to 10 minutes for people with pale skin and 60 to 80 minutes for people with dark skin. It could be much longer in the winter or in Maine. To get optimal vitamin D, if 40 percent of the skin is exposed (e.g., wearing shorts and a short-sleeved shirt with no hat), all you need is a quarter of your MED every day. In a bathing suit it may only take 1/8th MED.

Most foods do not contain a significant amount of vitamin D, but you can find vitamin D-fortified milk, yogurt, cereals, breads, and infant formula. Fatty fishes such as tuna and salmon might contain almost all the recommended amount of vitamin D in just one serving. In comparison, a child would have to drink a quart of fortified milk to get the same amount.

One reliable way to ensure your children are getting the recommended daily amount of vitamin D is to add the vitamin to their daily routines. Breastfed babies should start getting drops containing 400 IU shortly after birth. Another way to accomplish this could be for nursing mothers to take 4000 to 6000 IU daily. Formula-fed babies and toddlers should start taking vitamin D also, but not until months later when they start drinking less than 32 ounces a day of formula or milk. Older children may also benefit from a multivitamin containing 400 IU of vitamin D.

Choosing a Vitamin for Your Child

By Alan Greene, MD, FAAP

You already back up your computer’s hard drive. Why not back up your child’s food drive too?

Kids are designed to thrive on a balanced diet of fresh fruits, veggies, whole grains, beans, nuts and lean sources of protein and calcium. But in reality, most children today don’t get nearly all of the vitamins, minerals and other micronutrients they need from what they eat. A daily multivitamin or mineral supplement can help to greatly improve children’s overall health.*

A daily dietary supplement can help fill in the small nutritional holes, gaps and cracks that are so common in children’s diets. Since kids’ bodies and brains grow especially quickly in their first three years, begin supplements after your child’s first birthday.

Not all vitamins are created equal. When choosing a vitamin, avoid:

• Hydrogenated vegetable oil
• Artificial dyes (Blue No. 2, Red No. 40, Yellow No. 6)
• High fructose corn syrup
• Artificial flavors
• Artificial sweeteners such as aspartame
• Preservatives such as butylated hydroxytoluene

When deciding on a vitamin, look for natural options, as well as ones with low sugar and no allergens.

How much does your child need? It depends on her diet, but in general, be sure your child is getting enough of the most important vitamins, minerals, and nutrients (see The Greene 13, below, to find out which ones are my top priority). Most children don’t need large amounts of vitamins or minerals.

Whatever you choose, the simple habit of taking a daily supplement will back up your child’s food drive and help set her up for a long, healthy life.*

The Greene 13

Kids commonly don’t get enough:

1. Calcium

2. Fiber

3. Folic acid

4. Iron

5. Magnesium

6. Omega 3 fatty acids (especially DHA)

7. Phosphorous

8. Potassium

9. Vitamin A

10. Vitamin C

11. Vitamin D

12. Vitamin E

13. Zinc

Making the Case for Vitamin Supplements

By Alan Greene, MD, FAAP

No matter how well intentioned people are about making sure they get the right balance of vitamins and minerals, they face tough obstacles. With breastfed newborns, the scale is tipped in the right direction (except for vitamin D). After infancy we are biologically designed to thrive on a balanced variety of whole foods, such as fruits, veggies, whole grains, beans, nuts, and lean sources of protein and calcium. But natural instincts to eat the right amount of healthful, balanced foods can be tricked by sugar- and fat-laden empty calories that make up a good portion of the American diet.

Even if people learn to choose fresh, sweet corn over processed corn chips, they face another challenge: today’s natural foods do not contain the same level of micronutrients they used to. The typical American consumes too many calories, but the extra calories do not translate to adequate nutrition. We often get suboptimal levels of many key nutrients and phytonutrients that scientists are just beginning to understand.

Missing the mark on vitamins and minerals is especially worrisome for our kids and expectant mothers. As a pediatrician, I worry most about “the Greene 13”: calcium, fiber, folic acid, iron, magnesium, omega-3 fatty acids (especially DHA), phosphorus (except for kids who drink carbonated beverages and get too much phosphorus), potassium, vitamin A, vitamin C, vitamin D, vitamin E, and zinc. These micronutrients can affect children’s growth, behavior, and/or immune systems – and typical American children do not get enough.

Over the years I’ve learned to appreciate vitamins and the role they play in our health, especially the healthy development of our children. I’ve seen firsthand how a mother’s vitamin intake can help a growing infant, even before she conceives. I’ve monitored the decrease in the value of the nutrients that our children digest, even when we think we’re feeding our families all the fruits and vegetables they need to stay healthy.

Take vitamin D, for example – one of the critical Greene 13. A recent study found that children with low levels of vitamin D have a higher chance of respiratory concerns, and related research looked at how vitamin D might help respiratory health. Earlier studies suggest that adequate vitamin D might support many other systems in the body.

Earlier this year the American Academy of Pediatrics doubled the amount of vitamin D they recommended for our kids. But parents are going to have to work a little harder to meet these new levels, as it has become more difficult to get enough vitamin D in recent years. Kids are consuming less vitamin D-rich foods such as tuna and vitamin D-fortified milk (in favor of sweetened drinks with less nutrition). They spend less time outdoors during the middle of the day, and when they do, they need to wear sunscreen. A study released this year showed that forty percent of healthy babies and toddlers were not getting enough vitamin D – and an earlier report said the same about American teens.

Another Greene 13 nutrient that’s tough to get naturally is the omega-3 fatty acid DHA, an important nutrient that studies have shown helps support healthy joint function, cardiovascular health, and helps to enhance mood and support a healthy state of mind.

Although everyone can benefit from taking a balanced multivitamin, women of childbearing age and children have special needs. One of the most critical times for good nutrition may be the trimester before the pregnancy test turns positive. Thus, I recommend a prenatal vitamin for women who may become pregnant. Babies or toddlers can start on liquid vitamin drops when they slow down on breastfeeding or formula. Breastfed babies should get at least 400 IU of vitamin D starting soon after birth. When kids can start chewing pills, I look for palatable supplements that do not mimic candy or contain sweeteners or artificial coloring.

Of course, in the developing world, adding supplements to a diet isn’t as easy as going to the vitamin aisle in a drugstore. More than 30 percent of the world’s population suffers from micronutrient deficiencies. One non-profit organization has dedicated itself to decreasing the problems caused by malnutrition by providing supplements to children and expecting mothers in developing countries and communities in need. Vitamin Angels (www.vitaminangels.org) is focusing on distributing vitamin A to at-risk children. The program is privately funded with donations from vitamin manufacturers, companies and individual donations. I give to Vitamin Angels each year because this charity does so much with every dollar that I give. I've travelled with Vitamin Angels to the Dominican Republic to see the program at work. I've never seen such a big improvement in people's lives achieved so inexpensively and so quickly.

Questions for your doctor

Before you start any diet or exercise program, be sure to consult your physician. Because among other things, there are medications and other conditions that may impact your weight or ability to exercise.

Here are some suggested questions to ask your Doctor or Dietitian before starting a weight loss and exercise program.

  • Am I overweight?
  • What should my target weight and BMI (Body Mass Index) be?
  • Is my weight affecting my health?
  • Do you recommend that I see a specialist to rule out any medical conditions that could be responsible for my excess weight?
  • Is it safe for me to exercise?
  • Are there any types of physical activity that I should avoid?
  • Are there any types of foods should I avoid?
  • What type of foods should I try to incorporate into my diet?
  • Do you recommend that I meet with a Registered Dietitian to improve my diet?
  • Am I taking any medications or do I have any health conditions that would prevent me from taking dietary supplements to support my weight loss program?
  • Is there any reason I should limit my caffeine intake or should I try to stay below a certain amount of caffeine per day?

For those with current medical conditions or who are any taking medications, ask your doctor:

  • Is it safe for me to lose weight?
  • Will weight loss improve my current medical conditions?
  • Does the medical condition interfere with weight loss?
  • Will any medications I am currently taking prevent weight loss?
  • Are any of my current medications contributing to weight gain?
  • Will weight loss alter my medication dosage?
  • What kind and how much exercise is recommended?
  • Is it ok for me to take dietary supplements to support weight loss?

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