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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 ( 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.


The word “yoga” comes from Sanskrit with the dual meanings “union” and discipline.” By uniting meditation with a series of postures, practioners of this ancient Indian exercise seek to develop both mental and physical wellbeing.

Yoga is a great way to stretch, increase flexibility and strength, reduce tension, and relax body and mind. In our hectic, stressed out world, yoga has become a popular and widely accessible form of exercise. People of all ages can practice yoga and it can be adapted for people with disabilities or special needs.

Getting Started

Sign up for a yoga class, rent a video, or check your local T.V. listings for yoga programs. Learn the proper form for the postures (asanas). As with all exercise, regular daily sessions will provide the most benefit.

Body Benefits

Yoga stretches and postures are accompanied by deep steady breathing that improves blood circulation, soothes the nervous system, and increases vitality. You will enjoy improved flexibility, a slight increase in muscle strength, good posture and long, lean muscles. Yoga also enables better physical balance and coordination. Additionally, a number of studies have shown that yoga can benefit those with joint pain or insomnia. Other benefits include stress reduction and an improved ability to concentrate.

While yoga doesn’t usually provide aerobic benefits, a new version known as Ashtanga or Power Yoga adds a cardiovascular element. Rather than the traditional series of slow, gentle stretches, Power Yoga employs a rigorous choreographed sequence of poses synchronized with your breathing to provide a hot, high-energy workout.

Warming Up and Cooling Down

If your muscles are particularly tight you may want to try some gentle stretches before your yoga class or workout. Otherwise yoga sessions generally include a warm-up and a cool-down. You may find it helpful however, to take a few minutes to clear your mind and to prepare mentally for class.

If you are practicing yoga at home or if your instructor does not include a cool-down, simply shake your body out and walk around for a few minutes.

Note: If you are practicing Power Yoga and your routine does not include a warm up or cool-down, remember to follow the same preparations you would for any aerobic activity. Gently stretch to prevent injury and start exercising slowly to warm your muscles. Allow a ten-minute period towards the end of your program in which you slow your motions and allow your heart rate to decrease. Stretch again to avoid soreness and to enhance flexibility.

Busting Through A Strength Training Plateau

Plateaus are a common obstacle in strength training. In fact, unless you continuously re-evaluate and update your fitness program, it is likely that you will hit a plateau after about six months, once the strength gains you’ve achieved in the first few months of training begin to level off. The good news is, with a little bit of effort, you can overcome, or even prevent yourself from hitting a strength training plateau in the first place.

They say that variety is the spice of life. It is also the key ingredient to overcoming or avoiding a plateau. After performing the same exercise routine for several months, your muscles become efficient at performing those movements, and you no longer continue to progress as you did when you first began your workout regimen.

Varying the intensity of your workout by making your muscles work harder, as opposed to longer, is one of the most effective ways to break through a strength plateau. If you’re able to do 10-15 reps at your current weight using proper form, try increasing the weight by 5 to 10%. You may need to decrease the number of reps at first and work up to a full set.

Another way to add variety to your workout is to cross-train. Cross-training will not only help to keep your workout interesting, but will also work your muscles in a different way. If you usually use weight machines at the gym, try using free weights or resistance tubing. You can also combine exercises, such as using free weights while doing squats.

Changing the sequence of exercises in your existing routine can also help to add variety to your workout. Additionally, it will cause your muscles to fatigue in a different order, forcing them to adapt to the change and allow for a variation in your strength gains.

Though sometimes it may be enough to simply change the sequence of exercises in your fitness routine, it’s a good idea to periodically re-evaluate your routine. You may find that you need to replace some or all of the exercises, particularly those that you’ve outgrown or that are redundant. Look at the muscle group being used in each exercise, and replace it with an exercise that targets the same muscles.

Some final thoughts:

  • Sometimes hitting a plateau may be a result of overtraining, which may also make you more susceptible to injury. Make sure that you give your muscles an adequate amount of time to recover between workouts. During the recovery period, your body adapts to the training you are engaging in, making rest an essential factor in your progress.
  • Good nutrition is key to a successful fitness program; the nutrients you consume will help to fuel your workouts and to help your muscles recover afterwards. (Check out our article, Foods To Keep You Energized and Motivated to learn more.)

Please Note: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any diet or exercise program.

How To Relieve a Side Stitch

The side stitch, also referred to as exercise related transient abdominal pain (ETAP), is a common condition experienced at one time or another by most people who regularly engage in sports or exercise.

Characterized by a sharp, stabbing pain just beneath the ribcage, this frustrating cramp occurs most frequently during vigorous activity that involves a lot of up and down movement, such as running or jumping. The pain is caused by a spasm of the diaphragm muscle when the ligaments extending from the diaphragm to the internal organs (particularly the liver) are stretched.

Though it can occur on either side of the abdomen, the side stitch occurs much more frequently on the right side. Why is that? When you inhale, your lungs fill with air, and your diaphragm is forced downward. When you exhale, your lungs contract and your diaphragm rises. While running, approximately 70% of people exhale as their left foot hits the ground with only about 30% of people exhaling as their right foot hits the ground. The latter group is more likely to experience side stitches. As the right foot hits the ground, gravity pulls your internal organs, including the liver, downward. If you are exhaling at the same time, then your diaphragm rises as your lungs contract, resulting in stretching of the diaphragm. This repeated stretching can lead to spasms in the diaphragm.

To treat a side stitch, it is best to stop, or at least reduce the intensity of, the activity that caused the stitch. Take deep, even breaths until the pain subsides. Applying manual pressure to the painful area can also help to alleviate the pain. If you tend to exhale as your right foot touches the ground, try to adjust your stride so that your left foot hits the ground as you exhale.

There are also steps you can take to prevent side stitches from occurring in the first place:

  • Stretch thoroughly before exercising, focusing on the lower back and abdominals.
  • Avoid eating for one to two hours before a workout, because food in the stomach can create more force on the ligaments and increase cramping.
  • When running, make sure to take deep, even breaths, as shallow breathing leaves the diaphragm consistently raised, not allowing the ligaments to lower far enough to relax.
  • Drink more fluids to avoid dehydration, which can increase muscle cramps.

When Is the Best Time to Exercise?

There are many theories out there concerning when the best time to exercise is. But the first question to ask is what is your goal? Because for some people, “the best time” means the time when we are strongest or burn the most calories; for others it’s the time that fits into our schedules or makes it most likely that we’ll stick to a routine long-term. Or it could even be the time that whatever event you’re training for is starting, like an early morning marathon.

Let’s take the first scenario—you want to find out when your body is most ready for exertion. We’ll assume that you’ve tried a few different times of day and can’t determine which is working best for you (because if you already know your body well enough and know when you workout most efficiently, you can stop reading now).

The human body follows circadian rhythms, which result from the firing of neurons originating in the hypothalamus region of the brain. These rhythms are set according to the 24-hour cycle of darkness and light and regulate things like your body temperature, metabolism and blood pressure (that’s why you feel awful when your sleep schedule gets out of whack).

You’ll probably have a more productive workout when your body temperature is at its highest because your muscles are warm and more flexible. Studies show you have more power, quicker reaction time and resting heart rate and blood pressure are low. For most people, body temperature is highest during the late afternoon (it’s usually lowest about one to three hours before you wake up in the morning).

All this doesn’t mean anything if you don’t have time to exercise in the afternoon or can’t realistically commit to a long-term routine of working out at this time. If you know you’re more likely to stick to working out if you do it in the morning, then that’s the most important thing to concentrate on.

If you’re training for a specific event like a morning marathon or afternoon event then it may be best for you to train at the time that you will be performing. You’ll get a better sense of how your body can perform at that time of day and you’ll get into a habit of exerting energy at that time.

How to choose a personal trainer

If you’ve decided to start working out with a personal trainer but don’t know how to be smart about finding one, read on.

You may have heard about specific trainers from friends, or seen trainers at your gym. No matter where you find them, the first thing to consider is your safety. You should be sure to work with someone who has a current certification accredited by the National Commission for Certifying Agencies (NCCA). Don’t train with someone who is not knowledgeable about the human body and who could put your safety at risk. It’s a good idea to ask to see the person’s certification and to make sure it’s current. You can also call the NCCA to look someone up in their system or to make sure their status is current.

The next step is to ask for references. You may not need this if the trainer comes personally recommended by someone you know very well, but it may still be a good idea. Try to speak with people who are at the same fitness level as you or have the same goals (like training for an event or just trying to get a little more fit).

Once you’ve narrowed down the list, speak with your potential trainer(s). See if you feel comfortable in your interactions and make sure you are able to communicate well and freely with each other. Be sure to bring up any health conditions, pre-existing injuries, goals or concerns and see if the trainer responds in a way that makes you feel confident about his or her knowledge and interest in training you.

Next, it’s time to talk money—find out what the trainer charges for sessions. Many factors can come into play, such as the trainer’s experience and credentials or whether he or she needs to travel to come to you or if you will meet at your gym. Go over the cancellation policy and billing procedure; if you’re not totally clear on these processes you may end up incurring extra fees.

If your trainer is not an employee of a fitness facility you should find out if he or she carries professional liability insurance.

Your final steps should be to make sure that your schedules are compatible, you can both easily get to the location where you’ll be working, and any other miscellaneous concerns that may come up.

If you have additional questions or concerns, consider calling the NCCA or visiting their Web site.

*Mention of specific companies or brand names does not imply any affiliation, connection, association, sponsorship, or endorsement between such company and this material or Twinlab, including its affiliates, and further, nothing should be construed as implying that this material or the goods of Twinlab originate with or have the sponsorship or approval of such company.

How to buy an elliptical trainer

Because of the convenience and cost effectiveness of having exercise equipment right in your home versus going to a gym, many people are choosing to buy elliptical trainers for low-impact cardio exercise.

A quick search online will give you an idea of the top brands, and many websites feature reviews from people who have already made purchases. Read through those and look for trends in satisfaction or dissatisfaction with different brands. You also want to find brands that offer a warranty and servicing or calibrating (if you choose a model that requires calibration).

Another thing to consider is whether or not you want a motorized model. If you opt for a motorized machine, make sure you have an adequate power supply in your home—and that you want to pay a higher electrical bill.

Before you head to the store, find out how much space you have available for the trainer and take those dimensions with you. You don’t want to bring it home and find out there’s not enough room for it. You need to consider the space above your head, as well, since you’ll be elevated above the floor when you’re on the machine. You should also consider whether or not you’ll be storing the machine between uses, and if so, make sure you have enough storage space.

Once you get to the store, try out the models you’re considering. Check for noise levels, stability and sturdiness, format of the control panel and ease of use. When you’re on the machine, make sure your posture doesn’t feel strained and your range of motion is not cramped or limited. Obviously, you want to be sure your feet fit the pedals.

Pro bodybuilder, Todd Jewell, explains that it’s also important to take your weight into consideration. “I am a large man weighing in at around 300 pounds in the off-season, so I have to make sure that the equipment I use will hold up to that amount of weight over a long period of time,” he says. In other words, don’t be stingy, spend the extra money if it means you’ll be safer and the machine will last longer.

Finally, before you start using your trainer, be sure that you know where all the controls are and if you have a motorized model, that you know where the emergency off-switch is.

Workout Ideas for Couples

Hectic schedules can sometimes make it difficult to set aside enough time to dedicate to your fitness regimen and also spend enough quality time with your significant other. Relationships, much like fitness regimens, require lots of time and commitment, and at times it may seem hard to balance both. But these two priorities don't need to come in conflict - working out together can help you both achieve your fitness goals while spending quality time together.

Working out as a couple has several physical as well as emotional benefits. Men and women tend to focus on different types of exercise when working out; Men usually favor strength training, while women typically focus on cardio. Exercising together can help to balance out each of your workout programs to incorporate both cardio and strength training. Partners can also help to watch each other's form and serve as a spotter during difficult exercises. In addition, exercising as a couple gives you a common interest and allows partners to give each other motivation and support, which can help deepen your bond.

It can be tricky to start working out with a partner, particularly if you are at different fitness levels. Below are some suggestions that will help you get a good workout together.

  • Join a class together. Pick an activity you're both interested in trying; from kickboxing to yoga to swing dancing, the possibilities are virtually limitless.
  • When using cardio machines at the gym, work on machines that are next to each other. This will allow each of you to work at your own intensity level while still being close to each other.
  • Challenge your significant other to a high-energy game of basketball. Rouse up a little friendly competition and start burning calories!
  • Go for a power walk or jog outside. Walking at a brisk pace can be great exercise, plus you'll get to enjoy the scenery and outdoors together. Adding intervals to your walk or jog will help to accommodate both your fitness levels.
  • Stretch it out. Assisted stretching has been shown to help improve flexibility and feels good, so give your partner a gentle tug or push, just be careful and go slowly to ensure you don't overdo it.
  • Go play outside. Remember as a kid how you would spend endless hours playing outside? Recreate those childhood memories with your partner - play a game of tag, jump rope, or go for a bike ride.