Vitamin D: Recommendations for Children

In 2008, the American Academy of Pediatrics (AAP) recommended that vitamin D be increased from 200 IU to 400 IU per day for children. Vitamin D is required for calcium absorption and promoting bone mineralization. Vitamin D deficiency in children can cause rickets, a disease that affects the developing bones of children. According to the AAP, children 1 year of age and older should consume vitamin D from vitamin D-fortified milk and other fortified foods and take a supplement if needed, under guidance by a pediatrician.

Milk is one of the most important sources of vitamin D (and calcium) in pre- and school aged- children. If your child consumes three 8-ounce glasses of low-fat vitamin D-fortified milk a day, they will get 75% of their daily value (DV) for vitamin D. However as many parents know, it is difficult to get a child to consume one glass of milk, let alone three!

A couple of years ago my son stopped drinking milk (once I took away his sippy cup) and I was faced with the reality that I was a parent (with degrees in nutrition) whose son did not drink milk ! I hadn't expected this dilemma because my son loved his milk (but obviously it was the sippy cup he loved more). So I broke my first preconceived nutrition notion which was "no chocolate milk allowed" and proceeded to give him low-fat chocolate flavored milk a couple of times a week. It contains more calories and twice the amount of sugar as white low-fat milk (even now the makes me cringe!) but it also contains the same amount of vitamin D. The way I view this is as follows: imagine your child is learning to drive, you let them practice in your new car but you purchase an old car for them, different vehicle but it gets them from point A to point B. Thats how I see chocolate milk - as a different vehicle, not ideal, but hopefully they'll upgrade soon !! I kept offering my son white milk and eventually he did try it again and I soon weaned him off the chocolate milk (once its not in the fridge the battle stops!). As a nutritionist I encourage you to give your children low fat white milk, but as a parent I know sometimes this is an impossible battle, and we have to approach the battle field from a different angle!

With respect to supplements, I think giving your child a multivitamin supplement that contains 200 IU of vitamin D, particularly in the winter months, is a good idea. My advice is aim to get at least half your childs vitamin D requirements (i.e. 200 IU) from dietary sources - milk, fortified orange juice, breakfast cereals and fish, and the other half from supplements. Alternatively, try your ancestors remedy - a teaspoon of cod liver oil ! This contains 400 IU of vitamin D. Perhaps the new flavors of cod liver oil disguise the taste - let me know how you get on with that one!

Question Everything

After reading my blog on vitamin D, I was asked some excellent questions.

One friend asked "Just tell me how I can get 1,000 IU a day from my diet ? This question was followed by, oh and by the way, I am NOT getting my blood taken!"

"Its really difficult to get 1,000 IU from diet alone. Most brands of multivitamins contain 400 IU and so I recommend you take a multivitamin. With respect to food sources, the richest source of vitamin D comes from fish. For example, a portion of cooked salmon (3.5 ounces) contains 360 IU, canned tuna in oil (200 IU), or cooked shrimp (140 IU). Other sources include dairy products, such as a cup of milk (100 IU) or a yogurt (80 IU) . You can also get vitamin D from orange juice that is fortified with calcium + vitamin D (100 IU), or from Viactiv calcium soft hews (1 chew = 100 IU), or fortified breakfast cereals (40 IU). And with respect to the blood sample, keep traveling to sunny places and you should be fine ! No need for a blood sample my brave friend"

Another question raised was "Hold on, the label on my multivitamin says I am getting 100% of my daily value (DV) for vitamin D, so this is good, right ?".

"Ok, I can see your confusion. The recommended adequate Intake (AI) for vitamin D is 400 IU. This is the level stated in the Dietary Reference Intakes (DRIs) and is the level assumed to ensure nutritional adequacy. Most dietary supplements contain 400 IU of vitamin D and so it states 100% vitamin D in one supplement. However, most experts believe this is set way too low and the recommendation (by experts in the field) therefore is to increase your intake to 1,000 IU/day"

Another friend asked "You mention that there are two forms of vitamin D, do both forms, D2 and D3, naturally occur in foods ?".

"This is a good question and let me clarify this for you. The vitamin D found in most foods, and in some dietary supplements, is in the form of D3 (but you should check the supplement label). D3 is usually derived from animal sources. Fortified soy milks (e.g. Silk Soymilk) and other soy based drinks contain the less active form of vitamin D, D2. Vitamin D2 is usually derived from yeast."

To my friend who loves ice cream - "sorry to tell you this but ice cream is not a source of vitamin D!"

Please keep asking questions, you can e-mail me at beyondnutrients@gmail.com

Don't Doubt Vitamin D !

Experts in the field are convinced we are not getting enough vitamin D and the evidence is pretty convincing. There is a growing list of health conditions and diseases that vitamin D deficiency/ insufficiency* has been linked to, such as

Osteoporosis
Type 2 Diabetes Mellitus
Cardiovascular Disease
Muscle weakness
Fractures
Cancers
Autoimmune diseases
Dementia
Hypertension

To mention just a few...

*criteria for deficiency is a serum 25(OH)D [25 hydroxyvitamin D] less than 50 nmol/L, and vitamin D insufficiency is a serum 25(OH)D between 50 and 80 nmol/L (experts believe this reflects a vitamin D status that is too low to prevent some disease).

Last year I was vitamin D deficient. I suspected that I was deficient for several reasons:

(1) I live on the East Coast.
(2) I lather myself in sunscreen from May to September (tanning is not an option for most Irish).
(3) I don't drink any milk (there is a story behind that one).
(4) Like most, I only consume fish once a week.

A simple request to my Dr. asking that she test my serum 25(OH)D levels confirmed what I had suspected and so now I take a vitamin D supplement.

Nutrition 101:
Upfront, there are two points you need to keep in mind. First of all, there are three ways you can get vitamin D (1) through sunlight exposure, (2) from food, and (3) from supplements. Second, there are 2 forms of vitamin D: D3 (cholecalciferol) and D2 (ergocalciferol). Vitamin D3 is the most potent form of vitamin D. It is more effective at raising serum 25(OH)D than vitamin D2 and, it is more effective at maintaining those levels for a longer time. Most supplements now contain vitamin D3, rather than vitamin D2 (but make sure to check the label).

Sources of vitamin D:
Most people know we get vitamin D from sunlight. If like me however, you use sunscreen, you block the UV rays and therefore prevent the absorption of vitamin D in your body. Also, keep in mind the further from the equator you live, the weaker the UV light (note to Irish friends....even on those sunny days you're at a disadvantage!)

With respect to diet, there are few foods that are naturally rich in vitamin D. These include fatty fish, some fish liver oil, and eggs from hens fed vitamin D. Milk products, breakfast cereals, infant formula, and juice can be good sources if fortified with vitamin D. Contrary to what you may believe, most cheeses and other dairy products are not fortified with vitamin D.

**NOTE: THIS SECTION IS NOT NECESSARY TO READ IF YOU'D RATHER SKIP AND GO STRAIGHT TO THE BOTTOM LINE (SEE BELOW).
Regardless of where vitamin D is obtained (sun exposure, food, and supplements) it is biologically useless! It needs to go through 2 steps in the body to become active. The first step occurs in the liver where vitamin D3 is converted to 25-hydroxyvitamin D [25(OH)D]. As mentioned above 25(OH)D is a blood measure of vitamin D status. The second step occurs primarily in the kidney, where 25(OH)D is converened into the physiologically active form 1,25-dihydroxyvitamin D [1,25(OH)2D]. This is a hormone and it plays many roles in human health. One of the most important roles of vitamin D is in promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone.

How much vitamin D should I have in my diet?:
Most experts are recommending 1,000 international units (IU) a day. Check to see how much you are getting from your multivitamin, calcium supplement (most include vitmain D) and then from foods.

(Go to: http://ods.od.nih.gov/factsheets/vitamind.asp#h3).

You should be aware that there is a current recommended tolerable upper intake level (ULs) for vitamin D (i.e. the maximum that is considered safe). This is set at 2,000 IUs a day. Most experts however believe this is set too low and that higher intakes appear to be safe. If you are prone to kidney stones or kidney problems I suggest you seek advice from your doctor. The main reason is that too much vitamin D will cause your body to absorb too much calcium and this can lead to kidney problems.

BOTTOM LINE:
So, here is my advice:

Get your serum 25 (OH) D levels measured at your next physical examination.

Aim to consume 1,000 IU daily (most multivitamins contain 400 IU).

If your serum 25 (OH) D levels are low at your follow up visit, discuss taking a vitamin D supplement.

4 Steps to a Healthier Lifestyle

My friend doesn't believe that I am overweight. Nope, she is not listening to a word of it ! Perhaps I should have stressed 'slightly' overweight, but the 'slightly' part of the sentence still places me at increased risk of developing a chronic disease !

Below is the information you need to help you achieve a healthier lifestyle. I will cover more on each step in future blogs, but for now here is a quick summary and some websites you can visit.

Step 1: The first step to changing a behavior is to acknowledge a problem exists. Check out your weight status using the Body Mass Index (BMI)** calculator and assess your risk. Which BMI category do you fall into ?

* Underweight = <18.5
* Normal weight = 18.5-24.9
* Overweight = 25-29.9
* Obesity = BMI of 30 or greater

** BMI Calculator (http://www.nhlbisupport.com/bmi/)

Step 2: Record your diet. Be honest with yourself. Keep a diary for a week and write down everything you eat and drink. Do you eat off your children's plates ? I am so guilty of this - I hate waste!

There are are resources available to help you calculate your dietary intake. To be honest, it is time consuming and, if you have the financial resources at hand, you may want to pay a nutritionist to analyze your food diary. If not, enjoy the experience of calculating your daily intakes. You can do this by using the "MyPyramid Food Guidance System". MyPyramid offers personalized eating plans, interactive tools to help you plan and assess your food choices, and advice to help you.

Website: http://mypyramid.gov/

So once you know how many calories you are consuming, you can work to modify your diet.

Step 3: How much exercise do you get ? I suggest you get checked out by your physician if you have not been engaging in regular physical activity. Once you get the all clear to start exercising, take it in small steps !

For the first time, Physical Activity Guidelines for Americans exist. The key guidelines for adults are as follows:

All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.

For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.

For additional and more extensive health benefits, adults should increase their aerobic physical activity to 300 minutes (5 hours) a week of moderate intensity, or 150 minutes a week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity. Additional health benefits are gained by engaging in physical activity beyond this amount.

Adults should also do muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.

So become more physically active !

Step 4: Take care of yourself emotionally. We often neglect our emotional needs, particularly if we are busy with our work and our family life. We forget to pause and reflect. We spend too little time being quiet and still. Try yoga, taking a long walk, listening to music, getting a massage - do something that helps you check out of your hectic life for a short time. And here is the tough part, do it without feeling guilty!

Changing any unhealthy behavior is difficult - it takes strength and determination ! Take small steps first and be honest to yourself!

What's SO Bad about Banana Chips ?

I am always on the look out for healthy snacks to put in my children's lunch bag. I avoid the potato chip aisle every week. If I do buy potato chips my children assume we are going on vacation ! Last week I picked up a carton of banana chips and tossed them into my cart. I didn't give it much thought - they were banana chips after all !

So nutritionally speaking how do they compare to potato chips ?
Based on the on 1/2 cup serving:

150 calories
8 g total fat (of which 7 g is saturated fat)
0 g sodium
20 g total carbohydrates
1 g fiber
1 g protein

Compared to a small bag (1 oz) of plain, unsalted potato chips

152 calories
9 g total fat (of which 3 g is saturated fat)
2 g sodium
15 g total carbohydrates
1.4 g fiber
2 g protein

So when you look at it, nutritionally speaking, banana chips are not any better than potato chips! In fact, banana chips are deep fried in coconut oil, increasing the saturated fat content. If you are on weight watchers, eating 1/2 cup of these fried chips will cost you 3 points. But here is the kicker, 1/2 cup is only 15 banana chips. A portion of potato chips will cost you the same points, but you kind of expect that to be the case.

As shocked as I was by the nutrition facts, I was in greater shock after reading the ALLERGY INFORMATION AND CAUTION statement. It reads as follows:

"Packed in a facility that handles peanuts, tree nuts, milk, soy, wheat and egg products. Due to harvesting practices, it is possible this package may contain pits, twigs, stems, or other naturally occurring objects".

Right, well dead bugs might fall into the naturally occurring objects category !! Where is this facility ???. Regardless of the facility location - the bottom line is that banana chips, while sounding like a better alternative to potato chips, are not.

Note to self: Slow down in the supermarket and look at the product labels !

ACAI (Ah-sigh-ee) Berry Drink

Since I'm on a liquid kick these days, I decided to shake things up a little by trying this SUPERFRUIT drink, manufactured by BOSSA NOVA (which is Portuguese for "new trend"). I tried the Acai juice with mango - it was excellent ! My husband was so pleasantly surprised by the taste (he gave a thumbs down to Dr Oz's drink) that he suggested making a vodka cocktail with it ! Great idea, but not at 7 am in the morning.

Some Facts:

The Acai berry is a deep purple, grape-sized berry, that grows in the Amazon Rainforest of Brazil.

It is rich in phytonutrients (biologically active compounds heavily concentrated in the skin of the berry).

It has more than 30 times the antioxidant power of red wine.

It contains omega fatty acids (healthy fats).

It is a rich source of vitamin C and dietary fiber.

And last but not least

The locals in Brazil call this Acai berry the “Viagra of the Amazon"!

OK those are the facts about the Acai berry .... now lets switch focus and talk about the beverage.

First, their labeling is good !! Some real selling points listed...

Taste: Lush, tropical dark berry with a blueberry note.
I concur with this statement.

Superpower: Highest antioxidant fruit.
True and a nice graph included on the bottle to illustrate this point.

Benefit: Reduces free radicals linked to premature aging, heart disease, Alzheimer's and certain cancers; anti-inflammatory benefits; supports recovery after exercise. So I'd guess they've captured the attention of at least 60% of Americans with this selling point.

(Intersting, no mention of it being a good 'mixer'!)

Nutrition Facts (Mango flavor): The first thing to note is that there is 1.2 servings in the bottle and so while they list 90 calories on the label, if you drink the bottle, you'll actually be consuming more calories. It has 18g of sugar (natural sugar found in the fruit), 0 g dietary fiber and some vitamin C and A.

My opinion: It tastes good but it is expensive. I paid $3.29 cents for this 10 fl oz drink! I have to admit, I'd much rather eat my calories than drink them, unless of course its in the form of a cocktail! So, I'm going to keep an eye out for the real deal - the actual Acai berry. I'll keep you posted should I find it - I'm thinking Whole Foods might carry it.

Question everything.....

Euripides said, "Question everything. Learn something. Answer nothing." Oh, this sentiment certainly holds true when we talk about diet and health. When people ask me questions, I find I contradict myself or sound extremely uneducated because the nutrition field is always changing. Many simple questions have complicated answers and, often, there is no ‘right’ answer. Let me give you a couple of examples:

Are dietary carbohydrates bad for you?
Eh, no....well yes...well some are better than others.

Does soy food protect against chronic disease?
Depends on what disease you have in mind!

Should I use butter or margarine?
Try olive oil.

What about high fructose corn syrup, harmful or not?
Conflicting results.

What is a prebiotic and probiotic? And why are they good for me?
Oh boy, do you have an hour?

Through my blog, I will try to answer these questions, but be warned - you may be frustrated by the response!

My friends often ask me questions about diet and health. I’ve classified these inquiring minds into two personality types: the comedians and the skeptics.

The comedians ask questions like, “How many calories are in a Snickers bar?” or “Why is a tomato a fruit and not a vegetable?”or “French fries are potatoes, so they count as a serving of vegetables, right ?” As a former professor once said “There is no such thing as a silly question,” and so let me respond to the above: 271 kcal (2 oz bar), botanically speaking its a fruit (contains seeds) and NO!

And then you have the skeptic – the person who wants to hear your opinion on the topic, but doesn't believe a single word you say. They usually start with a statement like, “My grandmother ate RED MEAT and POTATOES daily, used BUTTER on mounds of WHITE bread and enjoyed her nightly hot whiskey - she lived until she was 90 years old.” Fair enough! This dietary pattern worked for one of their family members – she enjoyed all the foods that we tell people to eat in moderation! Sometimes I find I just can't hold back. I try, but I just can't. I probe further, “So tell me, did your grandmother exercise?” “Oh yes, walked everywhere....no car.....three miles to the nearest shop.” (Note: If the nightly hot whiskey didn’t tip you off, event takes place in Ireland.) I usually follow this question with something along the following lines - “Things are so more convenient nowadays – closer stores, more variety of foods and bigger portions.” Who can argue with that? Bottom line? Your grandparents' genes have left their imprints on you, but your environment has changed and thus we need to consider the interaction of the two.

So from skeptics and comedians to curious minds alike, I welcome your questions. I can't guarantee I'll know the right answer or that I'll even get to your question but I will try! Keep an eye out for our weekly “Question everything” post. Email me at beyondnutrients@gmail.com

Dr. Oz's Green Drink – Bottoms Up !

After my friend Kate gave me her list of immune fighting dietary supplements, I recalled watching the Oprah show on which Dr. Oz promoted his “Green Drink". So, without haste, I sent the recipe to Kate and wished her luck drinking this daily concoction ! Here is how it looks:

Ingredients:
2 cups spinach
1 medium cucumber
1 celery stick
1/2 inch or teaspoon ginger root
1 bunch parsley (about ½ cup)
2 apples
Juice of 1 lemon
4 oz. of spring water or a handful of ice cubes

Note: This recipe serves 1 to 2 people.

So what do you do with all these greens ? Throw them in a blender, puree it for a couple of minutes and then serve it in wine glass and knock it back !

What's the health benefit ? Nutritionally speaking, its loaded ! If you drink the entire amount you are going to get approximately 12 g of dietary fiber (**recommendation for dietary fiber posted below). Plus, its rich in antioxidant vitamins A, C and E. Antioxidants protect our cells from free radical damage and they help repair the damage when it occurs – keeping us healthy. These vitamins will help regulate the immune system and help prevent or fight infection. Another health benefit of this smoothie is that it is nutrient dense i.e. lots of nutrients compared to the number of calories. It contains approximately 215 calories. If you are on weight watchers and counting points, this smoothie will cost you 3 points. Keep in mind that you may only want to drink ½ of the portion and you are therefore consuming less calories/points.

My personal opinion: If it doesn't make you throw up, then you are over the first hurdle ! Interestingly, ginger is used in Asian medicine to treat stomach aches, nausea, and diarrhea. Hmm, perhaps this is why a slice of ginger root it is added to this smoothie.

I'm a firm believer to give things a try at least once before you come to any conclusion. So I plan to try this for 14 days. I may modify it a little - a shot of vodka perhaps (just kidding !). I will keep you posted on how the experience goes and should you decide to join the bandwagon, share your comments on how you think it tastes!

Bottom line: You will boost your immune system with this low calorie, fiber rich smoothie if you can tolerate the taste !!


**Daily Recommended Fiber Intake
Women
25 grams per day, for women younger than 50
21 grams per day, for women older than 50
Men
38 grams per day, for men younger than 50
30 grams per day, for men older than 50

New Journey

Welcome to my blog ! A little about myself – I have a B.Sc. and a Ph. D. in nutrition. For several years now I have been publishing research papers, writing book chapters, consulting for food companies, lecturing and serving on the editorial boards of nutrition journals. Until recently, this was my passion – asking research questions, conducting science, mentoring students and contributing to the nutrition field. In the science field, I am referred to as a 'junior scientist' or a 'mid-level career scientist' ! In my opinion there is nothing junior about being almost 40 years old and both titles sound like I've still got a long way to go to achieve my full potential !

My real enthusiasm lies in translating the science into practical information that will help my friends and family achieve a healthier, more balance diet. Recently, my close friend and writer of the Pointy Universe (http://pointyuniverse.blogspot.com/.), Kate, shared with me that she has breast cancer. How could this happen to my young friend ? This doesn't happen to us, does it ? My immediate reaction was “How can I help” ? Kate handed me a list of 8 dietary supplements she had ordered to help boost her immune system. I got it. You just don't get this news and sit back and do nothing at all to – you fight back ! I reviewed the list and despite my background was lost as to what was included in some of these supplements, the doses and the scientific justification behind their advertising. Oh boy, if I'm confused and feel lost, I'm sure other people out there feel the same.

So this brings me to this point, ready to start a blog, ready to tackle some of the questions my friend will ask over the course of her treatment, ready to breakdown the latest headlines on diet and health, ready to write about controversial topics and ready to embark on a new career. I look forward to the journey. Before I begin, let me first disclose a couple of things about myself:

1) For the record I try to eat healthy but I have been known to drive in and order from the menu of Dunkin Donuts and other fast food establishments !
2) I am not opposed to dietary supplements – I take a multivitamin, a vitamin D supplement and a fish oil capsule. I'm just a little skeptical of claims made about some dietary supplements, given the lack of scientific evidence.
3) I have a preference for whole-grain products. Do I eat refined grains ? Yes, but I try to substitute them as much as possible with whole grain alternatives.
4) I dislike soda but I do drink the odd diet coke.
5) I am overweight. My Body Mass Index (BMI) is a 26 kg/m2. I understand the struggles of trying to maintain a healthy body weight – its difficult – especially since fast food is so available and you don't even need to get out of the car !
6) I plan to become a Registered Dietitian (RD) at some point in my 'junior' career.
7) My New Years Resolutions – eat healthy, exercise more and keep a journal. I'm struggling with all three !
8) Last but not least, I'm married and a mother of two school-aged children (ages 4 and 6).