Tag: milk

Preventing and Treating Vitamin D Deficiency

More people seem to be getting the message that too little vitamin D in our diets can lead to health problems. In addition to being at risk of developing rickets (extreme vitamin D deficiency), children with milder forms of vitamin D deficiency can develop weak bones and muscle weakness.

Why is vitamin D so important?

Vitamin D is a hormone that helps our bodies absorb both calcium and phosphorous, two very important minerals that help keep our bones strong.

Without enough vitamin D, we absorb 85-90% less of the calcium in our diet! And then, to keep calcium levels normal, our bodies pull more calcium out of our bones, causing osteopenia and osteoporosis.

Some experts also think that a low vitamin D level is associated with other conditions that are not linked to calcium and our bones, including some psychiatric conditions. The American Academy of Pediatrics even states that “new evidence suggests that vitamin D plays a vital role in maintaining innate immunity and has been implicated in the prevention of certain disease states including infection, autoimmune diseases (multiple sclerosis, rheumatoid arthritis), some forms of cancer (breast, ovarian, colorectal, prostate), and type 2 diabetes mellitus.”

The role of vitamin D in preventing infections, cancer, or anything else beyond preventing and treating vitamin D deficiency (extraskeletal effects) is far from proven though. In fact, a 2010 investigation by the Institute of Medicine (IOM) didn’t find any evidence to support a role for vitamin D in any other health conditions besides supporting bone health.

Surprisingly to many people, the IOM report also found that most people in North America are already getting enough calcium and vitamin D in their diet and that getting too much can be harmful. They also warned that “the number of people with vitamin D deficiency in North America may be overestimated because many laboratories appear to be using cut-points that are much higher than the committee suggests is appropriate.”

Tests for Vitamin D Deficiency

Although vitamin D testing seems to becoming part of the routine screening tests that some doctors order, it is important to keep in mind that only those at risk for having low levels should be routinely tested.

Are your kids at risk for vitamin D deficiency?

These high risk children can include:

  • exclusively breastfed infants who don’t get a vitamin D supplement
  • babies born to mothers with a vitamin D deficiency, especially premature babies
  • children with chronic kidney or liver disease
  • children with malabsorption syndromes (Crohn’s disease, inflammatory bowel disease, cystic fibrosis, etc.), as vitamin D is absorbed with fats in our diet
  • obese children, because vitamin D is stored in fat tissue and is not readily available for use
  • children with dark skin, who live at high latitudes, and/or spend a lot of time indoors (less vitamin D from sun exposure)
  • children taking certain medications, including antiseizure medications and oral steroids
  • children who simply don’t get enough vitamin D – at least 400-600 IU of vitamin D each day, depending on their age. This might include vegetarians, vegans, and children who simply don’t drink vitamin D fortified cow’s milk, soy milk, or almond milk, etc., or other foods that are high in vitamin D.

If your child falls into one or more of these risk factors for vitamin D deficiency, then talk to your pediatrician about testing his vitamin D levels.

Although different tests are available, the test that is recommended by the AAP and the Endocrine Society is the serum 25(OH)D level (25-hydroxyvitamin D). This actually measures the levels of a prehormone of vitamin D, calcifediol, but is thought to give a good idea of a person’s vitamin D status.

This vitamin D test is preferred over testing 1,25(OH)2D levels, another test that is available, as those levels can be normal or even elevated when someone has a vitamin D deficiency. Similarly, measuring vitamin D levels (the active hormone) has not been found to be helpful. Instead, we use 25(OH)D levels as a marker for vitamin D levels.

Treating Vitamin D Deficiency

Is your child’s vitamin D level low?

That question is a actually a little harder to answer than you might realize. According to the IOM, in discussing cut-points for 25(OH)D levels, or what’s low and what’s normal, “At this time, there is no central body that is responsible for establishing such values for clinical use.”

The serum 25(OH)D level is typically defined as low (vitamin D deficiency) in children if it is below 20 ng/ml. Some experts think that a 25(OH)D level above 16 ng/ml is normal for infants and children though.

Experts do agree that a level below 5 ng/ml is a sign of a severe vitamin D deficiency.

Recommendations for treating children with low vitamin D levels depend on their age, and might include:

  • newborns: 1,000 IU /day vitamin D2 or D3
  • children 1 to 12 months old: 2,000 IU /day vitamin D2 or D3
  • children > 12 months old: 2,000 IU /day vitamin D2 or D3

These vitamin D supplements, together with adequate amounts of calcium, are usually continued for at least 1 to 3 months, at which time the child’s serum 25(OH)D level can be repeated to make sure it is responding to treatment.

“The upper limit for vitamin D is 1,000 to 1,500 IU/day for infants, 2,500 to 3,000 IU/day for children 1-8 years, and 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating teens and women. Vitamin D toxicity almost always occurs from overuse of supplements.”

NIH Vitamin D Fact Sheet for Consumers

The Endocrine Society also advises that some children can take 50,000 IU of vitamin D2 once a week as an alternative treatment for vitamin D deficiency. Since you can definitely get too much vitamin D, be sure to talk to your pediatrician and make sure your child is getting the right dose before starting a treatment regimen for vitamin D deficiency.

Preventing Vitamin D Deficiency

Once you get your child’s vitamin D levels back into a normal range, it is important to take steps so that they don’t drop again.

To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that healthy infants get at least 400 IU of vitamin D each day, while older children – toddlers to teens – get at least 600 IU. This vitamin D should come from some combination of:

  • foods that are naturally rich in vitamin D – salmon, tuna, shitake mushrooms, etc.
  • foods that are fortified with vitamin D – vitamin D fortified milk, orange juice, cheese, yogurt, margarine, and cereal, etc.
  • a vitamin D supplement – with just vitamin D, vitamin D plus calcium, or a children’s multivitamin

What about sunlight? Can’t your kids just spend more time in the sun to boost their vitamin D levels?

Although we all have the ability to make vitamin D when we are out in the sun, it isn’t considered a good source of vitamin D. Intentional, unprotected (no sunscreen) exposure to the sun has risks of sunburn and skin cancer. And it is very hard to judge how much sun exposure is necessary to get adequate amounts of vitamin D. The intensity of the sun’s radiation varies greatly in different parts of the world and at different times of year and will also affect how much vitamin D your body makes.

Other Things To Know about Vitamin D Deficiency

  • Raw milk, in addition to being unprocessed and unpasteurized, is unfortified and has very little vitamin D.
  • Although other foods may be fortified with vitamin D, in the United States, only milk, margarine, infant formula, and “fortified-plant based beverages” are mandated by the FDA to be vitamin D fortified.
  • In addition to low 25(OH)D levels, children with vitamin D deficiency will often have low phosphorous, high alkaline phosphatase, and high parathyroid hormone levels. These levels might be checked and monitored when kids are treated for vitamin D deficiency.
  • Vitamin D2 (ergocalciferol, derived from plants) and vitamin D3 (cholecalciferol, derived from animals) are two major forms of vitamin D. Some experts think that vitamin D3 is more potent than vitamin D2, especially at higher doses. Still, these prohormones are converted to the same active form of vitamin D (calcitriol) in the liver and kidney.
  • Some experts think that 25(OH)D levels between 21 and 30 ng/ml are a sign of vitamin D insufficiency in children, as in adults, and are a sign that the child needs more vitamin D in their diet.
  • Although the use of sunscreen can block the synthesis of vitamin D by blocking UVB radiation and has been blamed for lower vitamin D levels in recent years, many people likely don’t use sunscreen properly and don’t use it consistently enough and so “sunscreen use may not actually diminish vitamin D synthesis in real world use.”
  • Taking high doses of vitamin D is yet another nutrition fad which has been linked to serious consequences. Mega doses of vitamin D have been linked to kidney problems and tissue damage. That makes it important to stay below the upper limit that your child can likely take each day without causing harm, which ranges from 2,500 IU/day for toddlers to 4,000 IU/day for teenagers. Most only need 400 to 600 IU/day though.

Children with severe vitamin D deficiency are often managed by a pediatric endocrinologist or a pediatric nephrologist.

More Information on Treating Vitamin D Deficiency

  • AAP – Vitamin D: On the Double
  • The rise and inevitable fall of Vitamin D
  • Help Your Child Build Healthy Bones
  • NIH Vitamin D Fact Sheet for Consumers
  • Study – American Academy of Pediatrics Clinical Report. Optimizing Bone Health in Children and Adolescents. Pediatrics. Pediatrics Oct 2014, 134 (4) e1229-e1243
  • Study – Institute of Medicine Report. Dietary Reference Intakes for Calcium and Vitamin D. Released: November 30, 2010.
  • Study – The Endocrine Society. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, July 2011, 96(7):1911–1930.
  • Study – Misra, M. Vitamin D Deficiency in Children and Its Management. Pediatrics, Aug 2008; 122: 398 – 417.

Low Fat Foods for Kids

Although most kids get too much fat in their diets, there is one age group of kids for which you shouldn’t limit fat intake — infants and toddlers under age two years.

These children are still growing and need more fat in their diet than older kids. That doesn’t mean that you have to go out of your way to give your 18 month old French fries or have to avoid naturally low-fat foods, including most fruits and vegetables, but they shouldn’t drink low-fat milk, eat commercially made fat-free foods, or be put on a low-fat diet.

The only exception is toddlers who are already overweight or at risk of becoming overweight, who can switch to low fat milk before age two years.

Finding Low Fat Foods

As you learn to avoid high-fat foods for your children, it is just as important to learn to choose low-fat foods as part of your family’s healthy diet.

It is often easy to choose low-fat foods, as many clues are on the food label when a food is low, including nutrition claims that the food is:

  • fat free (less than 0.5g of fat per serving)
  • low fat (less than 3g of fat per serving)
  • extra lean (less than 5g of fat per serving and 2g of saturated fat)
  • lean (less than 10g of fat per serving and 4.5g of saturated fat)

Nutrition claims that are less helpful when choosing low-fat foods include the terms reduced, less, and light, since they only mean that the food has fewer calories or grams of fat than the regular version of the food.

For example, consider these chips:

  • DORITOS Nacho Cheese Flavored Tortilla Chips = 8g of fat and 140 calories per serving
  • DORITOS Reduced Fat Nacho Cheese Flavored Tortilla Chips = 5g of fat and 120 calories per
  • DORITOS Light Nacho Cheese Flavored Tortilla Chips = 2g of fat and 100 calories per serving

If you thought that the reduced fat chips were low fat, you would have been mistaken. They are not a bad choice, since they are not high in fat. You can find “potato chips” with even less fat though, including BAKED! LAY’S Original Potato Crisps, with only 1.5g of fat, and TOSTITOS Light Restaurant Style Tortilla Chips, which has only 1g of fat per serving.

Low-Fat Foods

Unfortunately, just because something is low in fat doesn’t meant that it is low in calories. So while you want to avoid high-fat foods, you also want to avoid foods that are high in sugar and calories. For example, most of the foods that rank at the top of the list for being low in fat in the United States Department of Agriculture National Nutrient Database for Standard Reference include candy, soda, and fruit drinks.

“Fat Matters, But Calories Count”

U.S. Department of Health & Human Services

Healthy low-fat foods can include:

  • Lettuce
  • Carrots
  • Tomatoes
  • Strawberries
  • Spinach
  • Egg whites
  • Baked potatoes
  • Grapes
  • Oatmeal cookies
  • Breakfast cereals (most brands, although some are high in sugar)
  • Watermelon
  • Air-popped popcorn (without added butter)*
  • Light tuna fish (canned in water)
  • Green peas
  • Wheat bread
  • Pancakes
  • Beans
  • Rice
  • Pretzels
  • Vegetable soup
  • Chicken soup with rice
  • Milk – 1% reduced fat and skim milk

In addition to the fruits and vegetables listed above, keep in mind that most raw fruits and vegetables, except for avocados and olives, are naturally low in fat.

What’s missing from the list of low-fat foods? Hot dogs, cheese burgers, French fries, milk shakes, chicken nuggets, tacos, and many other high-fat kids’ favorites.

Hidden Fats in Foods

Many low-fat foods become high-fat foods when parents unknowingly add high-fat or hidden fat ingredients to them, including:

  • oils, which are 100% fat and should only be used in limited amounts, with an emphasis on monounsaturated and polyunsaturated oils
  • butter and margarine
  • non low-fat cheese
  • mayonnaise (1 tablespoon = 10g of fat and 90 calories)
  • ranch dressing (2 tablespoons = 15g of fat and 140 calories)

Other foods made with hydrogenated vegetable oils, palm kernel oil, or coconut oil, are likely also high in fat.

What To Know About Low Fat Foods for Kids

While it is important to learn to identify low-fat foods and high-fat foods so you know what your kids are eating, your overall focus should be on helping your family eat healthy foods every day.

For More Information On Low-Fat Foods for Kids

The Best Milk for Kids – Does It Still Come from a Cow?

The new joke seems to be that you can turn anything into milk.
The new joke seems to be that you can turn anything into “milk,” even peas.

You wouldn’t think that the idea that kids should drink milk would be controversial…

Of course, it is.

The controversy is more over the type of milk now and not so much over the amounts though. Few people disagree with the American Academy of Pediatrics 2014 clinical report on Optimizing Bone Health in Children and Adolescents, in which they recommended that “Children 4 through 8 years of age require 2 to 3 servings of  dairy products or equivalent per day. Adolescents require 4 servings per day.”

Which Kind of Milk You Got?

While you used to have to go to Whole Foods to get soy milk, nearly every grocery store now has every type of “milk” you can think of, and some you haven’t.

So in addition to raw and pasteurized cow’s milk, it is possible to buy:

  • almond milk
  • cashew milk
  • coconut milk
  • flax milk (flax seeds)
  • goat milk
  • hazelnut milk
  • hemp milk
  • lactose free milk (cow’s milk without lactose)
  • oat milk
  • potato milk (as powdered milk)
  • quinoa milk
  • rice milk
  • ripple milk (peas)
  • 7 grain milk (Oats, Brown Rice, Wheat, Barley, Triticale, Spelt and Millet)
  • soy milk
  • sprouted rice milk

Complicating matters even more, once you decide on the type of milk to give your kids, you will have a lot of other options to choose from – organic, hormone free, sweetened vs unsweeted, enriched vs original, and a long list of flavors, etc.

The question is no longer simply Got Milk?

Best Milk for Kids

So which milk is best for your kids?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink.

What about the idea or argument that cow’s milk is made for baby cows?

Following that logic, if you weren’t going to give your kids cow’s milk, then you probably wouldn’t give them most plant based milks, as they are commonly made from seeds. Almonds, peas, and soybeans, etc., aren’t “made” to make milk. They are produced to make more plants. But just like we pasteurize and fortify cow’s milk so that we can consume it, we have learned to use these other foods.

Best Milk for Kids with Food Allergies

While the wide availability of so many different types of milk is confusing for many parents, it has been great for pediatricians and parents of kids with food allergies and intolerances. Having more of a variety has also been helpful for vegan families.

In general, you should breastfeed or give your infant an iron fortified formula until they are at least 12 months old, avoiding milk or other allergy foods as indicated if you are breastfeeding and your child develops an allergy, or switching to a hypoallergenic or elemental formula if your child develops a formula allergy.

And then, after your toddler is old enough to wean from breastmilk or formula, you:

  • should avoid cow’s milk, lactose-free cow’s milk, and goat milk if your child has a milk protein allergy
  • should avoid almond, cashew, coconut, and hazelnut milk if your child has a nut allergy (yes, even though almonds and coconuts are really stone fruits and not true nuts, they have been rarely known to cross react and trigger allergic reactions)
  • should avoid soy milk if your child has a soy allergy
  • should make sure your child’s milk is fortified with calcium and vitamin D

Most importantly, talk to your pediatrician and/or a pediatric allergist before switching to a plant based milk if your child has food allergies and before trying to switch back to cow’s milk after you think they have outgrown their allergy.

Other Things to Know About Kids Drinking Milk

Kids don’t necessarily need to drink any kind of milk. They do need the nutrients that you commonly get from milk, including fat, protein, calcium, and vitamin D, etc. You should also know that:

  • the American Academy of Pediatrics recommends that most toddlers drink whole milk until they are two years old, when they should switch to reduced fat milk.
  • switching to reduced fat milk can be appropriate for some toddlers who are already overweight or if their pediatrician is concerned about their becoming overweight or about their cholesterol, etc.
  • most cow’s milk that you buy in your grocery store doesn’t have any added growth hormone (labeled rBST-free), even if it isn’t organic
  • the AAP, in a report on Organic Foods: Health and Environmental Advantages and Disadvantages, states that “there is no evidence of clinically relevant differences in organic and conventional milk”
  • if a company makes more than one type of non-dairy milk, such as rice, almond, and soy, then cross-contamination could be a problem for your child with food allergies
  • most kids with a lactose intolerance can tolerate some lactose in their diet, so may be able to drink some cow’s milk and eat cheese, yogurt, and ice cream, even if they can’t tolerate a lot of regular cow’s milk
  • while plant based milks are lactose free and some are unsweetened, others might have added sugar, including cane sugar or cane syrup
  • unlike cow’s milk, most plant based milks are very low in protein
  • although they aren’t labeled as 1% or 2%, plant based milks typically have less fat than whole milk
  • phytoestrogens in soy milk are a concern for some people
  • most milk, even oat milk, is gluten-free, with the exception of 7 grain milk, which obviously contains wheat
  • UHT milk undergoes ultra-high temperature processing or ultra-pasteurization to allow it have a longer shelf life, even if not refrigerated, at least until the carton is opened
  • although some experts warn about cross reactivity, like between peanuts and green peas, the Food Allergy Research & Education website states that “If you are allergic to peanuts, you do not have a greater chance of being allergic to another legume (including soy) than you would to any other food.”
  • raw cow’s milk, in addition to being a risk for bacterial contamination and outbreaks of Escherichia coli, Campylobacter, and Salmonella, is very low in vitamin D and has no proven health benefits over pasteurized milk
  • reduced-calorie and no added sugar flavored cow’s milk often use artificial sweeteners
  • some brands of almond milk contain only about 2% of almonds, which leads some critics to say that you should just eat a few almonds to get even more nutritional benefits

But don’t forget about cost. Plant based milk can be at least two to four times more expensive than cow’s milk.

So again, remember that while each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut, etc.

For More Information On The Best Milk For Kids:

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