Your Child’s Nutritional Health

From kindergarten to post-puberty, children and teens are growing rapidly. There is a delicate balance between eating enough calories and nutrients for growth and development, while getting enough physical activity to prevent weight gain and chronic disease.

KEY NUTRIENTS IN YOUR CHILD’S DIET

Calcium is found in dairy products, such as milk, cheese and other dairy products. However, calcium is more readily absorbed from plant sources such as calcium fortified soy or rice milks and orange juice, legumes, almonds along with dark green leafy vegetables such as spinach and kale. Non-dairy sources of calcium are also lower in fat and calories. Magnesium, found in whole grains, nuts and seeds, help to incorporated calcium into bone.

Iron deficiency anemia is still widespread in children. Good sources of iron include whole grains, iron-fortified cereals, legumes, green leafy vegetables and dried fruits. Consuming foods rich in vitamin C (citrus fruits, broccoli, strawberries) at the same meal as high iron foods, enhance iron absorption.

FOOD ALLERGIES

Common allergens include milk, eggs, wheat, corn, citrus, nuts and seafood. In addition, celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. Recent findings estimate 1 in 133 people in the United States have celiac disease. Individuals with celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Today, a wide variety of food exists for individuals with food allergies, along with gluten free foods to manage celiac disease.

ATTENTION DEFICIT HYPERACTIVE DISORDER

Sugar in conjunction with artificial colors, dyes and additives may exacerbate attention deficit hyperactive disorder (ADHD). Parents can usually tell when their child has been exposed to too much sugar – especially when they come home from birthday parties filled with cake, ice cream and other goodies and tend to be wound up for the rest of the day. In addition, a 12-ounce can of caffeinated soft drink consumed by a child is equivalent to the effect of four cups of coffee consumed by an adult. Limit your child’s intake of sugar. Notice if your child’s behavior improves from a more wholesome diet.

CHILDHOOD OBESITY, HIGH CHOLESTEROL AND DIABETES

Children with high fat intakes are significantly heavier than children with low fat intakes. Childhood obesity is a precursor to heart disease and diabetes. Limiting fat, especially saturated fat, in your child’s diet is the best prevention and/or management of weight, cholesterol and diabetes, which uncontrolled, can lead to health complications later in life.

WHAT IF YOUR CHILD OR TEENAGER IS ATHLETIC?

VITAMINS AND MINERALS

Since athletic individuals are consuming more oxygen through aerobic exercise, an increased amount of “free radicals” are formed from the byproduct of oxygen formation as well as breathing in air pollutants can damage growing cells. Supplementation of vitamins C, vitamin E, and beta-carotene are recommended and the dose will vary depending on age and other circumstances.

IRON

A small amount of extra iron may be needed to aid in oxygen transport through the body. Sports anemia is common, which is the breakdown of red blood cells from impact of feet on the ground during running.

ELECTROLYTES

Sodium and potassium, which are referred to as “electrolytes”, are needed for water balance and proper muscle function, which can be achieved through normal fluid intake and eating fruits and vegetables daily.

ZINC AND CALCIUM

Other important nutrients include zinc for energy metabolism, as it tends to be lost in sweat and urine. Calcium is needed for strong bones and magnesium is helpful to prevent muscle cramps.

SPORTS DRINKS

Although water is the best way to hydrate the body, sport drinks with up to 10% sugar concentration are acceptable. Too much sugar lingering in the stomach will hamper performance. Some sugar intake will help preserve the body’s carbohydrate stores, maintain blood sugar and delay fatigue. Diluted juices work just as well as sport drinks. As far as how much fluid to drink before competition, 16 to 20 ounces are recommended two hours before and eight ounces 15 to 30 minutes before. While exercising, four to six ounces every 15 to 20 minutes is recommended, especially during long-term competition. You can be down up to two quarts of body fluid without actually feeling thirsty.

PROTEIN AND FAT

Athletes do not need any more protein or fat. Too much protein may be dehydrating. In addition, a low fat diet of no more than 20% is recommended.

COULD YOUR CHILD OR TEEN HAVE AN EATING DISORDER?

Today, young girls rarely feel good about their bodies. The current emphasis on beauty and the extraordinary pressure on females to be thin in order to achieve desirability are exceptional. According to statistics, 80% of adolescent girls feel bad about their bodies, 75% feel “fat,” and up to 70% are on diets at any given time. This behavior is extending to younger and younger children every day. Studies suggest almost half of 3rd to 6th grade girls say that they want to be thinner, and that 33% have already tried to lose weight. In addition, eating disorders are increasing prevalent in males.

WHAT IS AN EATING DISORDER?

Eating disorders are extreme expressions of psychological issues experienced by both boys and girls. They include anorexia nervosa, bulimia nervosa, binge eating and compulsive overeating. Anorexia nervosa is characterized by an irrational fear of body fat and weight gain, which contributes to drastic weight loss and refusal to maintain a height and age appropriate weight. With bulimia nervosa, cycles of binge eating and purging take place. Binge eating disorder or compulsive eating involves impulsive overeating with isolated fasts and recurrent diets.

WHAT ARE THE WARNING SIGNS OF ANOREXIA AND RELATED EATING DISORDERS?

Aside from extreme weight changes, behavioral signs that something is wrong are:

• Isolation

• Range of emotions from angry outbursts to no affect

• Procrastination

• Trouble in school

• Perfectionism

• Compulsive habits

• Omitting significant food groups at meals

• Change in sleep habits

• Loss of interest in formerly fun activities.

An eating disorder is a medical illness like any other disease, and will not go away without attention. If you suspect that your child has an eating disorder, it is important that you work with a team of professionals including your physician, psychotherapist, registered dietitian, and if necessary, a psychiatrist. This team of professionals’ can help you understand the impact of stress on your child and the rest of the family, teach healthy communication skills, and help you to assist your children to grow and individuate.

It is not so much what you say to your child, to convince them to eat healthier and have healthy food behaviors, but your own behavior that you model for your child rules. If you emulate healthy nutrition and lifestyle choices, your children will follow.

Ask the Doctor: January 2008

Question: I was watching Oprah and Dr. Oz mentioned that his favorite vitamin was vitamin D, and that a lot of people don’t get enough vitamin D. Why is that? I thought we got enough vitamin D from milk and the sun. – D.V., Grand Blanc

Answer: That is a great question! This topic has come up in a lot of conversations between me and my colleagues recently, and I agree with Dr. Oz. Vitamin D has been underrated for sometime.

The most common way that we get vitamin D is from the sun. When the sun hits your skin, it starts the production of vitamin D. Because of the shorter days and decreased intensity of the sun in the northern states and Canada, people living there (including the Detroit metro area) are more likely to be vitamin D deficient. Also, with the concern about skin cancers increasing, more people are using sunscreen and thus preventing the formation of vitamin D in the skin. Most dermatologists recommend a sunscreen with at least an SPF of 15 to prevent skin cancer; however an SPF of 8 will block enough of the sun’s rays that your skin will not make vitamin D.

Vitamin D can also be obtained through the diet. As most people know, milk is fortified with vitamin D. However, the vitamin D in milk breaks down easily, and by the time you have consumed about half of the milk in the carton, the vitamin D is no longer there. The other source of vitamin D in food is fatty fish like salmon or tuna. Of course, salmon and tuna contain many other important nutrients, like omega-3 fatty acids, so anytime you can eat these fish is good.

You can also get vitamin D from your multivitamin or over-the-counter supplement. Most doses of vitamin D in multivitamins are based on the recommended daily allowance, which we are now realizing is too low. The current recommendations for daily vitamin D intake was based on the amount of vitamin D needed to prevent rickets in children, which is not enough to prevent a variety of problems in adults.

The reason that we are so concerned about vitamin D now is that it is related to many common and serious illnesses. Vitamin D deficiency contributes to osteoporosis in post-menopausal women and can explain why some women still have hip fractures even when they are on medications to prevent fractures.

Vitamin D deficiency can cause muscle weakness and may contribute to the symptoms of arthritis. Vitamin D deficiency can also make the achiness that comes with the cholesterol medications known as “statins” worse. Before you stop your cholesterol medication because of aches and pains, ask your doctor to check your vitamin D level and replace the vitamin D if necessary. Your aches should improve as your vitamin D level goes up.

Vitamin D helps to keep cells healthy, and a vitamin D deficiency is linked to an increased risk of cancer. Those cancers that can be affected by vitamin D levels are colon, pancreatic, prostate, ovarian, and breast cancer. The risk of Hodgkin’s lymphoma is also increased by low levels of vitamin D. Vitamin D deficiency increases the risk of diabetes type 1, crohn’s disease and multiple sclerosis. Low levels of vitamin D can increase the risk for heart disease by mildly increasing blood pressure and increase inflammatory markers that are linked to heart disease, such as C-reactive protein.

Vitamin D deficiency can also contribute to depression. One of the theories behind seasonal affective disorder is that it is related to low vitamin D levels in the winter months. Seasonal affective disorder is related more to the amount of light during the day rather than the temperature, so the vitamin D theory may hold to be true.

The next time you go in for a physical or for blood work with your doctor, ask about having your vitamin D level checked. The normal range currently is 20-80, with anything below 10 considered to be severe deficiency. However, we find that people do better with levels higher than 20, so I treat my patients who have vitamin D levels less than 32. With clinically deficient patients, I am replacing their vitamin D aggressively with 50,000 IU once a week for 8 weeks, and then repeating the level check. Once the vitamin D level is above 32, the 50,000 IU tablet only needs to be taken once a month.

If you are vitamin D deficient, you will need to take supplements for the rest of your life. Over the counter formulations of vitamin D come in 1000 IU tablets. The 50,000 IU tablet is available by prescription from your pharmacy. Once you are back into the normal range, you could also take two over-the-counter tablets daily instead of the prescription monthly dose.

If you are not vitamin D deficient, taking the over the counter formulation once or twice a day can help you maintain your healthy levels. It is almost impossible to overdose on vitamin D, so if you want to take the supplement before having your level checked, go ahead. Taking vitamin D is an excellent way to prevent a number of serious diseases with a simple natural supplement a day.

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to: askthedoc@healthandleisureonline.com

* Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.