Multivitamins have been in the news lately — and the news is not so great.  Studies are showing that multivitamin supplements do little to help prevent chronic disease and promote health.  And preliminary research shows that in certain populations, they could even do harm.

Yet more than half of the US populations take multivitamins (53 percent) every day.  Kids take them too — 30 percent according to a 2009 study published in the Archives of Pediatrics and Adolescent Medicine.

Before you ditch multivitamins from your household, consider whether or not they truly enhance the health and well being of your family.  Here are three things to consider when making your decision.

1. Do they promote health? According to the 2010 Dietary Guidelines Report, there is little evidence that multivitamins prevent chronic disease.  On the other hand, people with healthy diets including fruits, vegetables, whole grains, nuts, beans, fish and little meat, have been shown to have lower chronic disease risk.

It is not just the vitamins and minerals in healthy foods that prevent diseases like diabetes and cancer, but the synergistic effects of phytonutrients, fiber and vitamins and minerals naturally found in food.  Research also dismisses the need to take additional amounts of antioxidant vitamins such as vitamins A, C and E as they do not appear to improve health outcomes as previously thought.

2. Is there any harm in taking them?  It is one thing if multivitamins don’t prevent disease but another if they are actually bad for health.  While most research shows no adverse effects of taking multivitamins, there are potential problems with getting too much, especially given the fact that many food products are fortified, including cereals, bars and drinks. 

While adequate folic acid in one’s diet is good for health, too much may not be good.  Some studies suggest that too much folic acid may increase the risk of cancers, especially colon cancer.  A recent Swedish study revealed that in a small sub-set of women, high folic acid blood levels increased breast cancer risk.  Research has also shown that supplementing with beta carotene increases the risk of lung cancer in smokers.

It’s important to note that the research in this area is far from conclusive and studies contain many inconsistencies.  There’s simply too much researchers don’t know about the combination of supplements people take and how they affect health.   The key is to aim for a healthy, varied diet and avoid excess amounts of vitamins and minerals through fortified foods and supplements.   

3. Am I (or my kids) missing out on key nutrients? The 2010 Dietary Guidelines Report acknowledges that multivitamins and supplementing with key nutrients are beneficial for certain populations.  The main reason for taking a supplement should not be for insurance, but to address key nutrients that are lacking in one’s diet.  Here are some tips to help you decide:

• Two recent studies showed most infants, toddlers and preschoolers get most adequate nutrition through food (except vitamin D). If children eat a variety of food, including fruits and (some) vegetables, they probably don’t need one.   Before giving kids multivitamins, check the amount of vitamins and minerals that come from fortified products.  Some children under 3 may benefit from a multivitamin with iron if they eat little meat and iron-fortified cereals. 
• The Center for Science for Public Interestrecommends men and post-menopausal women who consume multivitamins take them every other day so they don’t get too much folic acid.  On the other hand, women capable of becoming pregnant should take a multivitamin with 400 mcg of folic acid daily to lower their risk of having a baby with neural tube defects.
• Most people need additional vitamin D because the primary source is the sun.  Adults can get their blood levels checked at a routine physical and supplement if needed.  The AAP recommends that kids consuming less than 4 cups of milk daily take a supplement with 400IU daily.

 In my next series, I’ll address key nutrients that are most likely to be missing in your family’s diet, making the decision to supplement much easier.  Not knowing if your child is meeting his or her nutritional needs is unnerving so the goal of the series is to give you peace of mind.

Got any questions about this sticky topic of multivitamins?  Leave them in the comments.

References
2010 Dietary Guidelines Report

Shaikh U, Byrd RS, Auinger P. Vitamin and mineral supplement use by children and adolescents in the 1999-2004 National Health and Nutrition Examination Survey: relationship with nutrition, food security, physical activity, and health care access. Arch Pediatr Adolesc Med. 2009 Feb;163(2):150-7.

Ericson U, Borgquist S, Ivarsson MI, Sonestedt E, Gullberg B, Carlson J, Olsson H, Jirström K, Wirfält. Plasma folate concentrations are positively associated with risk of estrogen receptor beta negative breast cancer in a Swedish nested case control study. J Nutr. 2010 Sep;140(9):1661-8.

I’m excited to have Evelyn Tribole, MS, RD as our expert this month. She is an award-winning registered dietitian, with a nutrition counseling practice in Newport Beach, California. She has written several books including The Ultimate Omega-3 Diet and Intuitive Eating. She is a highly respected dietitian.

“Children require omega-3 fatty acids the same way they require vitamins,” Tribole says when asked the one thing she wants parents to know about omega-3 fatty acids. “But parents need to understand that it’s not just DHA (docosahexaenoic acid) their children need, it’s also EPA (eicosapentaenoic acid).”

The problem with fortified products on the market, she explains, is they contain only DHA. And children need both. Even though DHA is the star player, DHA and EPA work together in a complex process.

In her book, The Ultimate Omega-3 Diet, Tribole argues that DHA is needed for brain development the same way calcium is required for bone growth. She says that each brain cell requires DHA for proper development. When DHA isn’t present in adequate quantities during rapid brain growth (early childhood), emotional and intellectual development can be affected.

“Kids need to eat fish at least twice a week to get the recommended amount of DHA.” Tribole says. “Parents can try fish tacos, tuna fish sandwiches or salmon patties with their kids.”

While her son was growing up, Tribole took him out for “Fishy Thursdays” and he’d try all kinds of different fish at restaurants. Now he loves fish.

“Every time the FDA comes out with a warning about fish, consumption goes down, which is too bad,” she adds. “If parents stick to low-mercury sources of seafood like salmon, trout, halibut, light canned tuna and cod, they will be fine.”

Should children who don’t eat fish regularly supplement with DHA/EPA? Tribole says yes and based on international guidelines she recommends children 2-3 years old get 433mg of DHA/EPA with a minimum of 145mg of DHA, 4-6 years old get 600mg of DHA/EPA with a minimum of 200mg of DHA and 7 years and older including adults get 650 combined with a minimum of 220 DHA. For pregnant women the DHA minimum is 300mg. Check the supplement facts label to see how much DHA/EPA is in each serving.

As for recommended supplements, Tribole put together this chart on her website listing quality products categorized by cost. Supplements especially for kids include Coromega and Nordic Naturals. For another kids’ supplement, check out my review of Carlsons for Kids fish oil.

What about vegetarian children? Tribole explains that plant sources of omega-3 fatty acids such as flaxseed and walnuts do not contain DHA/EPA and convert very small amounts of DHA in the body. Most lacto-ovo vegetarians (consumes milk and eggs) don’t have problems taking fish oil supplements but vegans may be against it. There are algae-based DHA supplements but they don’t contain EPA.

Tribole emphasizes the importance of lowering omega-6 fatty acids in the diet. “I like to compare omega-6 fatty acids to sodium in the diet,” she says. “Both are essential nutrients but too much can take a toll on health.”

Because omega-6 (see sources below) and omega-3 fatty acids compete for the same limited enzymes, too much omega-6 can crowd out omega-3s. And too much omega-6 fatty acids in the body can increase one’s risk of inflammation, increasing the risk of developing chronic diseases.

Due to changes in the food supply, she explains in her book, we eat 10-20 times the omega-6 fatty acids our ancestors ate.

“To cut back I tell families to start with three items – margarine, salad dressing and spreads like mayonnaise.” she says. “These products are made with omega-6 vegetable oils such as soybean, cottonseed and corn oil.”

Vegetable oils low in omega-6 fats include canola and olive oil. She advises families to choose canola-based margarines like Canoleo or Canola Harvest, make their own salad dressing with canola or olive oil and buy a canola-based mayonnaise.

When asked other ways families can increase their intake of omega-3 fatty acids she says they can buy dairy products that come from “pasture-fed” or “grass fed” animals – and being organic is no guarantee. When animals are fed their natural diet of grass instead of a corn-grain diet, she explains, they naturally have higher levels of omega-3s and lower levels of omega-6. One example Tribole provides is Straus Family Creamery which sells pasture-fed dairy products.

She says the Mediterranean diet is a good example of a diet balanced with the right kinds of fat. For more on this fascinating topic check out Tribole’s book, The Ultimate Omega-3 Diet.

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For more on what to feed your kids see our Nutrition for Children section.

Yesterday the media was bursting with news about children and vitamin D. A study published in Pediatrics revealed that 70% of children –- millions of kids — have low vitamin D levels. Nine percent of 1 to 21 year olds were found to be deficient in vitamin D and 61% had insufficient levels. I couldn’t believe it when I read that only 4% of children were taking vitamin D supplements.

Why are so many parents choosing not to supplement their kids?

I don’t think parents understand how easy it is for children to fall short on the sunshine vitamin. And I especially don’t think they understand the impact that vitamin D deficiency can have on life-long health.

Research suggests that insufficient vitamin D not only negatively affects bone mass (Rickets only occurs with a severe deficiency state) but it is linked to the development of cardiovascular disease, diabetes, cancer and multiple sclerosis. In fact, the aforementioned study showed that kids with lower levels of vitamin D also had lower blood calcium levels, higher blood pressure and lower HDL (good cholesterol). For more information on vitamin D, see Is Your Family at Risk for Vitamin D Deficiency?

To help parents like you understand this public health concern, I’ve listed 4 key reasons why 7 out of 10 kids don’t get enough vitamin D.

Born to vitamin-D deficient moms: Kids aren’t the only ones with low levels of vitamin D. Many adults are at risk for vitamin D deficiency – and that includes pregnant women. If an expecting woman stays out of the sun, has dark skin or is overweight she is at increased risk. And expecting moms can’t necessarily rely on prenatal vitamins which contain 400 International Units (IU). According to the Amercian Academy of Pediatrics (AAP) policy report:

Supplementation with 400 IU of vitamin D per day during the last trimester of pregnancy has minimal effect on circulating 25-OH-D concentrations in the mother and her infant at term. An unsupplemented infant born to a vitamin D–deficient mother will reach a state of deficiency more quickly than an infant whose mother was replete during pregnancy.

It would be wise to test vitamin D levels during pregnancy so women would know if they need additional supplementation. During my recent pregnancy I took an additional 1000 IU of D. If you are pregnant, talk to your doctor about a vitamin D test.

Not enough time in the sun: According to the aforementioned study, children who watched more TV (spending time indoors) were more likely to have low vitamin D levels. But if parents lather their children up with sunscreen every time they go outdoors, they’re faced with the same problem.

The problem with relying on the sun for vitamin D is it’s hard to determine if it’s getting the job done. According to Michael Hollick, a leading vitamin D researcher, the hours between 10am and 3pm (10-15 minutes of sun exposure is recommended) produce the most vitamin D. So relying on late afternoon or early morning sun exposure may not be enough. And most parents are worried about the risk of skin cancer.

There’s not much D in food: Fatty fish such as salmon, tuna and mackerel and fortified milk and cereal contain vitamin D but that’s about it for food sources. Many parents feel their milk-drinking kids are safe. But according to the AAP, children would need to drink 4 cups of milk per day to make it to the 400 IU they recommend. And while milk plays an important role in young children’s diet, too much of it can displace other nutritious foods.

For babies and nursing toddlers, breast milk offers very little vitamin D. This is why the AAP recommends breastfed children be supplemented with 400 IU daily starting in the first few days of life. Formula is supplemented with vitamin D. See my product review for Carlson Vitamin D drops.

Public health recommendations are too low. The Institute of Medicine’s Adequate Intake for vitamin D is only 200 IU which is why the AAP has stepped up its recommendations. Due to the mounting research, the Institute of Medicine is in the process of revising its stance on vitamin D.

There’s little doubt that vitamin D insufficiency is an important public health concern for families all over the country. Take the time to talk to your doctor and get your levels checked. Many health experts believe that 1000 IUs is an appropriate amount for adult supplementation. And remember the AAP’s recommendations for children – 400 IU daily for breastfed children and older children not drinking 4 cups of milk per day.

As more news and research breaks, Raise Healthy Eaters will be there to break it down for you.

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I was searching for a “vitamin D only” supplement for my newborn and all I could find was Trivosol which contains vitamins A, C and D. I don’t see the need to add vitamins A and C…. I only wanted to add D. I went to a few stores and found nothing. I find this hard to believe now that the American Academy of Pediatrics recommends 400 IU vitamin D for breastfed infants starting the first few days of life.

Where are the marketers when you need them?

So I went someplace I knew had answers: Google. I was happy to find Carlson Vitamin D Baby Drops 400iu 11 ml drops. There was only one store in San Diego that sold them and my gracious mother-in-law picked it up for me. I could have ordered it online but time was of the essence.

These drops are very easy to use. You just put a drop on your nipple or bottle and baby sucks it down. You can also use these drops on your older kids by putting a drop in their milk or other beverages. Each little bottle should last a year – there are 365 drops. Pretty cool.

I was surprised that my son’s pediatrician said nothing about vitamin D at our 2-week visit. Maybe it’s because we live in Southern California where the sun shines daily? But like the AAP states in their policy report, it’s impossible to determine if any child or adult is getting enough D from the sun.

A recent study showed that one-third of new moms and over half of their infants were deficient in vitamin D at birth. Researchers from the University of Southampton found that women with low levels of vitamin D during pregnancy had children with lower bone density at 9 years of age. And research reveals that up to half of adolescents have insufficient blood levels of vitamin D.

Last year I wrote an article with vitamin D expert Dr. Michael Hollick – Is Your Family at Risk for Vitamin D Deficiency? Speaking with him opened my eyes to the long-term consequences of falling short on the sunshine vitamin – and they go far beyond bone health. If you have some time, check it out.

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References:

Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: longitudinal study. Lancet: 2006; 367(9504):36-43.

Marcason W. Vitamin D: are children and adolescents at risk for deficiency? Journal of the American Dietetic Association. 2009;109:952.

A recent study published in the Archives of Pediatrics and Adolescent Medicine brought up a topic that many moms wonder about: do children benefit from taking multivitamins?

When you think about how picky children can be with food, especially toddlers, it seems to make sense. Take a supplement, get a little insurance. But it doesn’t always work out that way and I’ll show you why.

How Many Children are Taking Vitamins?
In the above study researchers tracked over 10,000 children and adolescents 2-17 years of age from 1999 to 2004 and found that over one-third had taken a multivitamin in the last month. The interesting finding was that those children that were taking multivitamins didn’t necessarily need them. They tended to be the children with regular access to healthcare, balanced diets and had parents with higher incomes.

The study questioned whether multivitamins are being used appropriately – and on the right children.

How to Tell if Kids Need Multivitamins
First off, there’s no evidence that multivitamins are beneficial for children at all. In fact, the American Academy of Pediatrics (AAP) and the American Dietetic Association recommend that vitamin and minerals come from diet, not supplements. That’s because the benefits of vitamins and minerals are not isolated. Fruits and vegetables, for example, also contain fiber and antioxidants. Additionally, many foods are already fortified with vitamins and minerals (e.g., cereals, nutrition bars, specialty food items) making supplementation less of an issue.

In general, if your child eats a variety of foods (dairy, meats, whole grains, fruits and vegetables) and is at a healthy weight he or she probably doesn’t need a multivitamin. But if your child eats very poorly, is underweight, is on a restricted diet (that includes strict vegetarians) or has any other nutrition-related concerns then talk to your child’s pediatrician to see if a multivitamin, or supplementing with specific nutrients, is appropriate.

A Better Strategy
When children aren’t eating in a consistent manner, mothers think that giving a multivitamin will help cover their unmet needs. But doesn’t it make more sense to evaluate their diet and see what they’re missing — and then try to fix it with food?

Check the Resources section of this site for age-specific nutrition information which will continually be updated. If you can’t find what you need there, check MyPyramid for kids and get age-specific guidelines for your child’s nutritional needs. When you find your child’s diet is lacking in a certain area, then make an effort to add the food group back into his or her diet.

For example, if your infant or toddler eats very little meat you’d want to offer iron fortified cereals or other sources of iron with vitamin-C rich fruits/veggies to help increase the absorption. This is especially true for non-meat sources of iron which are not absorbed as well.

School-aged children tend to have low intakes of vitamin E, calcium, magnesium, potassium and fiber so make an effort to provide foods from these sources throughout the week. And many young children shy away from vegetables but readily accept fruit. Keep offering vegetables without forcing but vary their fruit intake by including vitamin-A sources of fruit such as cantaloupe and more acceptable vitamin-A rich veggies like carrots and sweet potatoes.

When Diet Isn’t Enough
Throughout this blog you’ll often see me write about vitamin D, a nutrient that has become a major public health concern. The scientific community is learning that most people (kids and adults) do not get enough – and most health experts believe current recommendations are too low.

The American Academy of Pediatrics recently changed its recommendation for breastfed infants to receive 400 International Units (IU) of vitamin D the first days of life. This should continue throughout childhood (whether they were breastfed or formula-fed) unless children are drinking one liter (four cups) of milk a day. The major source of vitamin D is the sun and with the increase in sunscreen use, most children — and adults — fall short. Insufficient vitamin D has been linked to everything from compromised bone health to the development of cancer to a variety of autoimmune diseases.

It’s also important for adults to make sure that they are getting enough vitamin D. A good place to start is with your annual physical. Ask for a vitamin D test to see if you have enough in your blood. If you don’t, your doctor is likely to recommend supplementation. This is important for those of you who want to have more children. If you are vitamin D-deficient during pregnancy, you’re likely to have a baby that is also lacking in vitamin D.

So check with your doctor, offer your child a variety of foods they need and supplement when there is good reason – and you can’t go wrong.

For more information on vitamin D check out the article: Is Your Family at Risk for Vitamin D Deficiency?

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References/Resources:

http://archpedi.ama-assn.org/cgi/content/full/163/2/192

Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake