News of vitamin D deficiency in children are popular in the media these days. Like all concerned parents, I am sure you have paused to pay attention to these news and wondered if you should get a vitamin D supplement for your toddler. The only way you can be sure whether your child has a vitamin D deficiency is by getting a blood test which screens for a particular form of vitamin D called 25-hydroxyvitamin D. Unfortunately, there are no early warning symptoms which can help you determine if you should take a corrective action.

You don’t need to go rushing for a blood test right away though! By paying attention to your child’s general level of outdoor activity and eating patterns, you can get a few clues. Here are 5 questions you can ask to figure out if there might be a need to get a definitive answer on vitamin D deficiency in your specific situation. However, you should not jump to a conclusion too soon just by observing over a few days. Rather you should try to look for a general pattern over a period of time.

Does he get enough time to play in the sun?

Your child’s body (and yours) is programmed to make its own vitamin D simply by being out in the sun. Even 10-15 minutes of play with arms and legs exposed to the sun can be enough. And best of all, the body is able to self-regulate the amount of vitamin D by storing the excess in fat cells.

The problem is that you may not get enough sunshine during the day, especially during the fall and winter months simply because of where you live. Children with darker skins are also at a disadvantage because of the pigment in their skin which absorbs the UVB rays which would otherwise be used to make vitamin D.

The good news is that the effect of sun is cumulative - that is, it adds up over time. Take advantage of every sunny day, even in the middle of winter to let your child play outside. Getting fresh air and physical exercise is good not only from the point of vitamin D, but also for overall physical and emotional health.

Does she drink at least 4 cups of milk every day?

Milk, by far, is the best source of vitamin D because all milk in the US is now fortified with vitamin D. However you need at least 4 cups to reach the recommended level of daily vitamin D (400 IU for children).

The problem could be milk allergies and just a natural dislike of milk. Also 4 cups is a lot, and even adults don’t usually get to drink that much on a daily basis. Try to mix with vitamin D fortified cereals, most of them generally are these days. You can also get vitamin D fortified orange juice, but be sure to watch out for added sugar.

One good way of increasing milk consumption is to add it to a smoothie. This way you can also get your child to eat some fruits!

Does he eat fish as part of a balanced diet?

Eating fish such as salmon is almost like buying insurance as far as vitamin D is concerned. You don’t have to eat it everyday – even once a week can work its magic. One serving of 3.5 oz (about 100g) or the size of a deck of cards can provide as much 2 times or even higher than the daily recommended level of vitamin D. Other fishes like tuna, mackerel and sardines are also good sources of vitamin D. Mercury contamination is a risk but should not be too much of a concern if you eat them occasionally as part of a varied diet.

The problem again could be allergies. Also your child may not like the taste or smell of fish. Trying new recipes and offering in small portions in combination with some of his other favorites can help you to build a taste for fish.

Does she seem overweight for her age?

Childhood obesity is on the rise and if your child is overweight or obese, you have a challenge in terms of vitamin D as well. That is because the body is not able to pull the vitamin D stored in the fat cells when needed.

Keep a close eye on her Body Mass Index by looking at the age specific growth charts. They are available on the CDC website or you can ask your pediatrician. Again, it is important to look at the trend and not a single point on these charts. If you see a trend creeping over the 85th percentile, you need to take action right away and improve the overall nutrition and eating habits of your child. Unless there is an underlying medical condition, nutrition and lifestyle changes can show good results.

Does he have special medical conditions?

In the most unfortunate situation, your child may have a medical condition such as Crohn’s disease, celiac disease or cystic fibrosis. These diseases cause poor absorption. Since vitamin D is a fat soluble vitamin, its availability is severely reduced in people suffering from these problems.

If this is the case, you are probably already talking to your pediatrician. Discuss the matter of vitamin D deficiency if you have not already done so.

After considering your specific situation, you can consult with your pediatrician about supplements. While I am not a fan of jumping on the vitamin supplements bandwagon, I think it is important to be informed about them. I plan to write about vitamin D supplements in future once I have had a chance to do some research on them.

What do you think? Are you concerned about your child’s vitamin D levels? Are you considering supplements? I would love to hear your comments.

Photo Source: Leo Reynolds on Flickr
©2009 Littlestomaks.com

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The media was abuzz this week with screaming headlines warning us of widespread vitamin D deficiency in kids. It followed a recent paper in the Pediatrics journal by researchers at the Children’s hospital in Boston, Massachusetts General Hospital, Harvard Medical School and the University of Colorado. The paper presented their research based on the 2001-2004 NHANES survey and posed the question Do Children Need More Vitamin D?

That the mainstream media latched on this latest research and gave it prime time coverage is not a surprise to me. I have written about such attention grabbing headlines on vitamin D before. I am so intrigued by the popularity of this topic in the press that I decided to look at this week’s news in more detail for today’s Five for Fridays. I would love to hear your comments and concerns about vitamin D for your children.

Here are 5 reasons why I believe we don’t need to let the mass media engulf us in mass hysteria about vitamin D:

There is no consensus on healthy levels of vitamin D in children

The Pediatrics paper correctly points out that:

There is controversy, however, about what a healthy level of 25-hydroxyvitamin D is for children and even what level of 25(OH)D should be used to define vitamin D deficiency

25-hydroxyvitamin D is what they measure in the blood to determine the level of vitamin D. Different agencies have defined vitamin D deficiency as blood levels less than 27.5 to 37.5 nmol/L. Many experts today believe that these levels are too low and should be revised to less than 50 nmol/L or even 70 nmol/L. By raising the number on the “safe” level, these experts suggest that a lot more people should be considered vitamin D deficient compared to current standards.

While there is some data to suggest various benefits of higher levels of vitamin D in adults (75 to 100 nmol/L), there is no such evidence and consensus for children. When even experts cannot agree on “safe” levels of vitamin D in children, I am not sure if it makes sense to raise a red flag based on this week’s report.

Average vitamin D levels in children are much higher than currently recommended

Amazingly, the Pediatrics paper reports that the average blood level of 25-hydroxyvitamin D was 70 nmol/L. Further, prevalence for levels less than 25 nmol/L was only 0.7% and that for levels less than 50 nmol/L was 15%. It is only when you consider a level of 70 nmol/L as the “safe” level that the prevalence goes up to 65%. Basically that means that most children have a sufficiently high level of vitamin D.

I am not suggesting that we should not worry about the 15% or so who had levels lower than 50 nmol/L. It is a cause for concern, but probably not as much as the rate of childhood obesity. The problem I have with these studies is that they tend to look at only one thing at a time and lose the big picture on our children’s health.

Perceived risks based on geography and ethnicity do not justify broad changes

We have all heard the usual reasons for low vitamin D – children do not get enough time in the sun which makes things worse for dark-skinned children of Hispanic and African-American background. Also children who live in the Northern altitudes do not get enough sun particularly in the winter months.

These observations are all true. However, aside from skin color and average sun exposure there is also an effect of poor nutrition in general. It is probably not a conincidence that children in these same demographic groups have also been reported as either overweight or obese. Under these circumstances, even if these children were put on vitamin D supplements, I am not convinced that it will do anything to improve their prospects of future health. I think that a narrow focus on vitamin D misses the big picture on children’s nutrition.

Based on these studies alone, I don’t think a sweeping across the board recommendation of higher vitamin D can be justified.

There is no evidence for preventive powers of vitamin D by large randomized clinical trials

A fascinating article appeard in last week’s Financial Times which posed the question To D or not to D? Recent research reports a link between higher vitamin D and lower risk of certain types of cancer. On the flip side, low levels of vitamin D have been reported to increase the risk of osteoporosis, heart disease, multiple sclerosis, type 1 diabetes, depression and rheumatoid arthritis. One recent review of health records of over 13000 Americans found that people with the lowest vitamin D levels were 26% more likely to die in an 8 year period compared to those with the highest levels.

How can you not have the sense of urgency about recommending everybody to have higher vitamin D? It seems like a no brainer.

Not so fast say the international health authorities! Even the International Agency for Cancer Research of the WHO issued a report last year that basically concluded there was no need to raise vitamin D recommendations. The Institute of Medicine in the US also does not appear to be in any hurry to change the current recommendations.

The main reason for this reluctance is that the preventive power of vitamin D has not yet been proven by large scale randomized clinical trials. The Financial Times article provides a good understanding of why such clinical trials may never take place. There are some clinical trials going on for senior citizens, but nothing on the horizon for children or young adults.

I am impressed by the commitment of today’s vitamin D researchers. However, I think there ambitions are out of proportion with their findings. I have nothing against targeted intervention in high risk groups, but it is meaningless to stretch the recommendations to everybody across the board.

These studies imply relying on supplements instead of nutrition and active lifestyle

Finally, this is the main reason why I am not a big fan of these studies. The underlying implication is that we can easily solve this problem by vitamin D supplements. The Pediatrics paper asks the question:

Considering these prevalence data, would there be risks associated with recommending that all children have vitamin D supplements until the short- and long-term health outcome data are elucidated?

It does address the concern about vitamin D toxicity but suggests that it is rare and happens only when really excessive doses of vitamin D are taken. Clearly, their agenda is to promote vitamin D supplements for children:

As suggested recently by the Canadian Pediatric Society and a recent stateof-the-art review on vitamin D, higher supplement doses may be required for children to reach the safe and potentially healthier levels of 25(OH)D of <50 or <75 nmol/L.

I think there is a real danger in such linear thinking. Instead of promoting healthy nutrition and physical activity first, and nutritional supplements second, the supplements are considered a primary means to good health. I reject that notion even though these studies get very high profile coverage in the press.

I am glad that a few Moms I talked to on Twitter about this topic calmly suggested that the real solution is to get your children to eat well, drink plenty of milk and play outdoors. At least they are not falling for this propoganda!

Have a good weekend and do let me know what is on your mind.

Photo Source: Wikimedia Commons
©2009 Littlestomaks.com

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We made this recipe with a ready-to-cook  Patak’s Jalfrezi Curry Cooking Sauce, which we  got from our local Indian grocery store. It is a mixture of green pepper, red pepper, coconut, sugar, onion powder, tomato puree and various spices. If you like the flavor of Indian curry, it is a great option for a quick meal. Good thing is that it is not too hot and you can use it with chicken or vegetables as well.

Ingredients

1. 1 lb lean beef, cut into cubes for stew
2. 1 small onion, finely chopped or crushed in a food processor
3. 1 15 oz. bottle of Patak’s Jalfrezi Curry Cooking sauce
4. 1-2 small red potatoes, peeled and cut into small cubes
5. A few baby carrots cut into small pieces
6. Chopped parsley or cilantro

Method

Wash the beef cubes, remove excess water and cook it covered in a small saucepan on low heat for about 45 minutes. It will turn soft and you should be able to easily cut it in small bite size pieces with a fork or knife. Add onions and olive oil in another saucepan and saute slowly for 3 – 5 minutes at medium heat. Add potatoes and carrots, mix and saute slowly for another 3-5 minutes. Add a full bottle of Patak’s Jalfrezi curry sauce and mix well. Cover and cook for 10 minutes or until softened. Add cooked beef cubes and mix well. Cover and let it simmer on low heat for 10 minutes to desired consistency.

About Patak’s Jalfrezi Sauce

Ingredients: Water, green pepper, red pepper, creamed coconut, sugar, onion powder, tomato puree, spices, canola oil, dessicated coconut, dried onion, corn starch, garlic, salt, vinegar, cilantro, roasted cumin, paprika extract color, cumin seeds, turmeric, paprika

Allergy advice: contains coconut and may have traces of peanuts or other tree nuts

Check out these links for availability online:

Indiablend.com
Amazon.com

©2009 Littlestomaks.com

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I have a guest post today on challenges of feeding our two little monkeys as we try to apply Ellyn Satter’s division of responsibility.

Simply put, division of responsibility means parents are responsible for what, when and where and the child is responsible for how much and whether.

Check it out at Dr. Kathleen Cuneo’s Dinner Together blog. Feel free to share your challenges and tips in trying to feed your little one!

Photo: Littlestomaks.com All rights reserved
©2009 Littlestomaks.com

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Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Dr. Douglas Husbands provides an update on nutritional supplements with practical application for the health of your children.

Question: What is the latest development in nutritional supplements for children?

Answer:

Hello everyone!  I’m delighted for my second opportunity to guest post here.  Since I just recently came back from the 2009 International and American Associations of Clinical Nutritionists Scientific Symposium, I’d like to share some information on nutrition supplements with practical application for the health of your children.

Vitamin D3

• Adequate to optimal levels of serum vitamin D levels in infants and children (between 30 to 60 ng/ml) are associated with decreased asthma and allergies, better brain development and healthy bone development.
• When visiting your pediatrician or Functional Medicine doctor, serum 25-hydroxyvitamin D levels should be measured.
• It is estimated that between 50,000 to 70,000 deaths per year from various causes could be prevented by having adequate blood vitamin D levels.
• Many infants and children could benefit from supplementing with 1000 to 2000 IU of vitamin D daily, particularly during the winter months, if they cannot tolerate fatty fish, if they are darker skinned, or if their serum vitamin D levels are below 30 ng/ml.

Probiotics

• Probiotics help decrease abnormal intestinal permeability, or “leaky gut”.
• The appendix’s function is now known.  It is a repository for beneficial bacteria (probiotics) for the GI tract.  Supplemental probiotics help replenish the repository after antibiotic use or from use of corticosteroid creams or inhalers.
• Abnormal intestinal permeability allows gut-derived antigen exposure to the bloodstream; thereby distant, seemingly unassociated autoimmune symptoms can arise from a “leaky gut”.
• Due to immature GI tract development, it is best that infants are breastfed for at least his/her first 12 months.
• Many pregnant women and breastfeeding mothers would do well to supplement with the probiotic strain Lactobacillus GG (aka Lactobacillus rhamnosus) at a dose of 4 billion/day and Vitamin D3 at a dose of 4000 IU/day for potentially decreasing likelihood of asthma, eczema, allergies, type 1 diabetes, and autoimmune disorders in their babies.

Curcumin

• Curcumin, a component of turmeric, has powerful anti-inflammatory properties to inhibit inflammatory mediators, exhibiting therapeutic potential in asthma (and other inflammatory disorders)

©2009 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

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Usually on Friday after work we take our kids to a toy train ride in a nearby open Mall. This Friday, as I was waiting for them to return from their train ride, I watched in fascination an interesting conversation between a hot dog guy and a woman buying a hot dog for her little (probably 4-5 year old) girl. It was one of those street corner hot dog stand just outside an upscale clothing store.

Mom comes out of the store with her daughter and sits down on a bench next to the hot dog stand.

“Mommy, I am hungry”

Mom notices the hot dog guy. “Would you like a hot dog honey?” she asks the child.

She doesn’t wait for her answer – which of course was a quick yes – and takes her by the hand to the vendor. As she orders the hot dog, she asks her daughter:

“What would you like to drink?”

“Sprite”

“Good choice! Caffeine-free sprite for you”, exclaims the vendor as he hands the hot dog and the Sprite can to the mother.

“That would be $4.50″

Just as the Mom hands him a $10 bill, he quickly adds:

“You know, you can make it a combo for another 50 cents and get a bag of chips”!

Mom doesn’t even pause, and asks her daughter:

“Would you like a bag of chips, honey?” as she points to the rows of chips on the overhead shelf.

The girl thinks for a moment as she eyes bags of Cheetos, Nachos and Plain Potato Chips.

She points to the bag of Cheetos. Mom takes it out, gets the change back and walks away with a hot dog, a can of Sprite and a bag of Cheetos.

What just happened?

For an extra 50 cents,  she got 160 extra calories and 290 mg sodium. She didn’t think much of it since she did not read the nutrition label on the bag. It was simply a matter of better value.

We are conditioned, almost like robots, to respond to the irresistible offer of a combo meal or a “supersize” option for only a little bit more money. Fast food sellers have figured out a way to “squeeze” out the last few cents from your visit by making it sound like a great deal. It works almost every time – the customer feels happy because it looks like they are getting more for their money, and the store makes more money per customer.

Next time you are offered the extra value combo meal, just pause and think if you really need those extra calories. If not, then save the 50 cents!

Photo source: Doonvas on Flickr via everystockphoto
©2009 Littlestomaks.com

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Greetings! Hope you all are enjoying the beautiful days of Fall. I simply love this time of the year. We are getting ready for Trick-or-treat and pumpkin painting, and the twins are excited! They are already dreaming of collecting candy – it is going to be an uphill battle trying to keep them from eating too much. I won’t spoil the fun by telling you their costumes this year yet, but will surely post a photo after Halloween.

Here are the 5 nutrition related news that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

A new index to help you select affordable nutritious foods

A new food rating system called the Affordable Nutrition Index (ANI) was introduced this week at the American Dietetic Association’s Food and Nutrition Expo in Denver. The idea is to provide a score that takes into account the cost of a certain food item in addition to its nutrition value. A food item with a high score means that it is high in 9 nutrients (protein, fiber, vitamin A, C, E, calcium, iron, potassium and magnesium), low in 3 nutrients (saturated fat, added sugar and sodium) and costs less on a per serving basis. Sweet potato, broccoli, green pepper, orange and banana scored high on the index (over 100) while packaged convenience foods scored lower than 100.

This index has been developed by Dr Adam Drewnowski, Director of the Center for Public Health Nutrition at University of Washington in Seattle. He used the Nutrient Rich Food Index (NFR9.3) which he previously developed and a price per serving information from food prices database, Seattle area supermarkets and industry sources. This research was sponsored by the Campbell Soup Company. Not surprisingly perhaps, many of the condensed soups from Campbell ended up with a high score around 100 compared to many fresh or cooked vegetables and even fresh fruits.

I am intrigued by this idea since we all want to select foods that have high nutritional value at an affordable cost. However, I don’t think that this is the only way to make that choice. I was disappointed to see that vitamin D was not included in the 9 nutrients to promote in the NFR9.3. Plus cost per serving is probably not the right measure of what a customer pays when buying a product. Also, you can manage cost by buying seasonal fruits and vegetables from local sources. Still, I think it is a good idea and I plan to write more about it in future.

Coke’s response to the debate on obesity is lame

Coca-Cola, the icon of sugary drinks is under attack! CEO Muhtar Kent wrote an Op-Ed piece in the Wall Street Journal on October 7th defending his company against proposals of soda tax. Coke Didn’t Make America Fat is what he believes; and quite arrogantly he points the finger to his own customers saying they lead a sedentary lifestyle! Well, Coke did make America fat according to my blogger colleague Dr. Ayala who wrote an excellent piece this week in response to Mr. Kent’s lame arguments.

So far, Coke’s response to the current debate on the role of sugary drinks in our obesity problem is rather lame in my opinion. They have announced that they will add calorie information on the front of Coke cans. They have given a large amount of money to the American Academy of Family Physicians (AAFP) to develop consumer education content as part of their Consumer Alliance Program. They are also a part of the Healthy Weight Commitment Foundation (HWCF), a group of 40 organizations seemingly engaged in a collaborative effort to address obesity. And now in their latest move, Coke has announced that they will introduce a 90-calorie mini soda can so that people can limit their intake of sugary cola.

While I am no fan of the twinkie tax, I do not believe that these actions by one of America’s top brands are of the high caliber needed to solve one of America’s most challenging health problems. Coke needs to do more than just pay lip service and make lame arguments defending their products in public. They need to take a more grass-roots approach – building playgrounds in schools, sponsoring healthy lifestyle events, developing after-school programs, integrating nutrition and physical education, sponsor healthy nutritious school lunches just to name a few examples. They need to measure the effectiveness of these programs in reducing obesity and make the data public.

Coke’ 3Q financial results show that they generated $6.3 billion in cash from operations year-to-date in 2009. They spent $241 million buying back their own shares. A little more of that cash spent on real programs to solve our obesity problem will not make a dent in their profits! What do you have to say about that Mr Kent?

FDA puts the hammer down on front-of-box labeling

The Smart Choice program it seems was the last straw according to Marion Nestle who writes a blog called Food Politics! In a letter to the food industry, the FDA is openly questioning the arbitrary nutrition standards used by companies to develop these labels which end up showing their own products as healthy. FDA wants to develop a set of independent criteria which these labels will need to meet before companies can use them on their products. FDA also wants to understand how these front of the box labels affect consumer choice.

I say, it’s about time. The Nutritional Facts panel, usually at the back or the side of the box, is too complicated for most consumers to read and understand. Consumers are looking for something simple that allows them to quickly make a decision.

We are lagging behind other countries in this area. A traffic light based food labeling system developed by the industry based on government guidelines in UK seems to be working very well. Why can’t we do the same here?

Here is a good background information on different types of front of box labeling systems. What is your opinion? Have you come across a labeling system you really like?

Toddler diets a cause for concern according to the 2008 FITS data

Latest data from the 2008 Nestle Feeding Infants and Toddlers Study (FITS) confirms the sorry state of a typical toddler diet in America. Most toddlers and preschoolers are not eating fruits and vegetables. They are consuming too much saturated fat and sodium. French fries are the most popular vegetable!

Good news is that the diets of infants and older babies are much better compared to the 2002 data. Mothers are breastfeeding their children longer and consumption of sugary drinks is decreasing. There is a risk of iron deficiency in some children.

Looks like parents and caregivers are following the feeding guidelines for infants. So why do things go south during the toddler years? Is it because of picky behavior? Or is it because toddlers eat what their parents eat? Or a combination of the two?

Not much progress has been made in the diet of toddlers since 2002. We need to make a deliberate effort to improve this situation.  Having dinner together, being a role model and encouraging fruits and vegetables is critical to solving the problem of childhood obesity. And in case you are struggling, here are some tips for picky eating.

Let us bring the school nutrition standards to the 21^st century

Can you believe that it was 1995 when the standards for the National School Lunch Program (NSLP) and School Breakfast Program (SBP) were last revised? Yet the NSLP served lunch to over 30 million children and SBP served breakfast to over 10 million children in 2008! If we are serious about fighting the battle of childhood obesity, we need to revise these standards and bring them to the 21st century!

Well, the good news is that the Institute of Medicine (IOM) has now issued its recommendations in a report titled School Meals: Building Blocks for Healthy Children, which the US Department is going to consider as they revise these standards. Recommended meal requirements encourage more fruits & vegetables, whole grains, min and max levels of calories and limit saturated fats  and sodium.

This is good news! I hope they will begin to implement these recommendations by the time our twins start going to school. I think progress may be slow due to cost and bureaucracy, but at least it’s a good start.

Enjoy and do let me know you think. I would love to have you share your best tips in comments below.

Photo source -cambodia4kidsorg on Flickr via everystockphoto

©2009 Littlestomaks.com

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This is a great recipe for a wholesome hot soup on a cold fall day! We stumbled on it in Recipes from the Heart, a cookbook we recently purchased to support the Operation STEM-ulus from the U.S. Foodservice to provide fresh fruits and vegetables to needy families. We adapted it slightly to match the ingredients at hand.

Ingredients

1. 1 medium butternut squash, cut into cubes (we bought it from Costco)
2. 1 small onion, finely chopped or crushed in a food processor
3. 1/4 cup all purpose flour
4. 3 cups organic chicken broth
5. 4 tbsp extra virgin olive oil
6. 1 cup whole milk
7. Chopped parsley or cilantro
8. Salt and pepper to taste
9. Pure honey
10. Unsalted cashews

Method

1. Place squash cubes on a baking sheet lined with aluminum foil, slightly greased with olive oil
2. Roast in oven at 350 °F for about 45 minutes, remove in a glass container when done and allow to cool
3. Add olive oil to a large pan and saute onions over low heat until softened
4. Add a dash of salt and pepper to taste. Skip the salt if chicken broth has high salt
5. Add roasted squash and flour, mix well
6. Add chicken broth, mix well gently pressing the squash cubes
7. Bring to boil, then lower heat and simmer covered for 20 – 30 minutes stirring occasionally
8. Puree the mixture with an immersion blender or a standard blender until smooth
9. Add milk and honey and let it simmer some more until desired consistency is reached. Add hot water if necessary
10. Garnish with chopped cilantro and unsalted cashews and serve hot!

About butternut squash

Source:Wikimedia Commons

Butternut squash is a type of winter squash with a sweet, nutty taste similar to a pumpkin. It has a very high nutritious value – rich in dietary fiber, A, B and C vitamins, and minerals such as calcium, iron, magnesium, phosphorus and zinc. Roasting is a common way of preparing butternut squash for soups and desserts.

A word of caution – some people may get contact dermatitis when handling butternut squash skin. Wear rubber or latex gloves while cutting or peeling. The allergic reaction is usually temporary and can be treated by over the counter cortisone cream.

©2009 Littlestomaks.com

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We got this new Gerber fruit snack for preschoolers this week. It was a great hit with the twins and they loved the chewy texture.

Here is what we like about this product -

1. Real fruit snacks, no added sugar
2. Only 35 calories per twist
3. No fat, cholesterol, sodium
4. Added vitamin C

Here is what we don’t like about this product -

1. Mostly made from fruit juice concentrate. Do not fall for the “real fruit snack” claim on the front of the box
2. Gerber also claiming that one twist is equivalent to half a serving of fruit for a preschooler. This is misleading because a processed snack like this cannot replace real fruit. Notice, it does not contain any dietary fiber!
3. It is not organic
4. High cost – a pack of 5 twists costs $2.99, which means each twist is about 60 cents.

Overall, I think not a bad alternative if you are on-the-go and need to offer a snack. But I would not rely on it to skip real fruits!

Disclaimer – I have not received any sponsorship or free samples of product from Gerber for writing this review. For complete nutritional information and other products, visit Gerber’s website.

©2009 Littlestomaks.com

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Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Family Physician and Registered Dietitian Dr. Shelley Meyer recommends you consider switching to 2% milk as long as your toddler is growing appropriately. Whole milk is recommended for children between 1-2 years old.

Question: How much whole milk is necessary? Should my nearly-17-month-old be drinking whole milk all the time? I worry about her fat intake a lot because there is heart disease and hypertension in our family in a BIG way – I want to get her started correctly down a road that will help her to avoid those issues.

Answer:

This is a great question that comes up quite a bit with parents of infants that are making their transition into toddlerhood.  Previously, the AAP recommended that any child between one and two years old have only whole milk.  The premise behind this idea was that the additional fat in whole milk was needed for appropriate development of the brain, as 80% of brain development occurs in the first two years.  In addition fat has more than twice as many calories per gram as carbohydrates and proteins, and is thus a great way to ensure adequate energy intake for the early toddler years.

However, due to the rising rate of childhood obesity and the increasing prevalence of cardiovascular disease in the general population, in 2008 the AAP revised their recommendations.  So, in your case, where there is a strong family history of heart disease, you may opt to use 2% milk as long as your child is growing appropriately.  In the case of an obese child 2% may also be the best option.   Remember, though, that fat is needed for brain development so be sure your young toddler is getting 45-50 grams of fat per day.

©2009 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

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I cannot believe that over a billion people worldwide are undernourished in the 21st century! Do we call this progress?

Right to food is a universally accepted fundamental right. Not only is this crisis a moral problem for the rest of the world, I believe it is also a security problem. Extreme poverty and hunger are breeding grounds for the spread of fundamentalism.

October 16, 2009 was the World Food Day sponsored by the Food and Agriculture Organization of the United Nations. The theme for the 64th anniversary of the World Food Day this year was Achieving food security in the time of crisis. Here are a few sobering statistics:

• Over 1 billion people worldwide are hungry and undernourished for the first time in history. That is nearly 1 in every 6 people in the world
• About a 100 million more people were added to the roster of the hungry this year compared to last year
• The declining trend in the proportion of undernourished in developing countries was reversed in 2008 and 2009
• Nearly 90% of the world’s hungry live in the Asia-Pacific and Sub-Saharan Africa

Certainly, the current global economic crisis has made things worse for everyone. But those in the low income countries and developing countries are disproportionately affected. There are a lot of smart people looking at the problem of food insecurity from an economic and resource point of view. However, we as individuals can take this opportunity as a reminder to reflect upon our relationship with food:

• Do we eat to live or live to eat?
• Do we know where our food comes from?
• Do we know if most of what we eat can even be called food?
• Do we know if the food we consume is produced in a sustainable way?
• Do we know about the waste and spoilage from farm to the fork?

Food is the fuel we need for life. Yet the only time we think about it is when our grocery bill goes up and we have to make tough choices. We are fortunate to be living in the land of plenty. Most Americans spend very little on food as a percentage of their total income. Still, we feel the pinch when price of bread and milk goes up by a small amount.

Many others in the world have no such luck. Some even spend their entire daily income on getting a few bites to eat.

We can send them our dollars in aid. But unless we examine our relationship with food in a fundamental way, we cannot hope to solve this problem anytime soon.

Now that is some food for thought.

©2009 Littlestomaks.com

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This is the National School Lunch Week. Improving the quality of school nutrition is one of the ways to address the problem of childhood obesity. It is encouraging to see that the USDA has established the HealthierUS School Challenge to recognize schools that promote good nutrition and physical activity. This week, Secretary Tom Vilsack is recognizing schools who have achieved the “Gold” status in this program. My question is: how come more schools are not participating in this program? The Secretary should address the barriers to his program’s adoption and measure performance in a transparent way. Only then he can hope to achieve the scale needed to truly address childhood obesity.

Here are the 5 nutrition related news that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

Honey! I shrunk the food ingredient list

In a positive trend, Registered Dietitian Janet Helm (@JanetHelm) points out that packaged food producers are scrambling to simplify and shrink the list of ingredients on their products. Michael Pollan should feel happy – after all, he is the one who has been telling people not to buy foods that contain more than 5 ingredients or difficult to pronounce ingredients! Actually, I agree with him and welcome this trend. Even though all these ingredients including additives, colorants and preservatives are considered to be safe, it just doesn’t make sense to me when I pick up a product which has over 20 ingredients. Why process the food so much?

Some of the new products – Haagen-Dazs five ice cream for example – now claim to be made just like the way you would make at home with only a handful of ingredients. Hmmm…I wonder if they cost more than the regular products! That would be a brilliant marketing idea – make more money with less!

Rice eaters have healthier diets – really?

A new study based on national food consumption surveys finds that rice eaters in general tend to have healthier diets because they eat more grains, more vegetables and dietary fiber, less added fat, less saturated fat and less added sugar. Rice is cheap and provides a rich source of carbohydrates.

I was intrigued by this news, not because we eat a lot of rice in hour household, but because the correlation implied that people should switch to rice! But then upon a closer look at the story I found that this research was sponsored by the USA Rice Federation. There is nothing wrong in urging people to eat more rice, but then the study should also point to the risks of eating too much rice. White rice is a refined grain and even when enriched with added vitamins and minerals, it is nutritionally inferior to brown rice. It also has a high glycemic index which will make your blood sugar rise rapidly. On the other hand, brown rice comes with an expiration date, may be more expensive, takes longer to cook and you may not like its chewy texture.

Just because someone eats rice, does not mean their diet is healthy on its own.

Home remedies for the common cold not backed by science

No doubt, eating warm chicken soup when you are down with the cold and flu is very comforting. But is there any scientific evidence that home remedies like the chicken soup, drinking plenty of fluids, vitamin C, zinc, echinacea, honey and garlic can treat or prevent your sickness? In an extremely well-researched article, Dr Ayala (@DrAyala) concludes that there is no solid scientific evidence on food, nutrients and relief from the common cold. Her advice – you can try these home remedies for comfort, and they don’t hurt except that you need to be careful about supplements.

I do take vitamin C every day, but I am under no illusion that it is the magic bullet for preventing cold and flu. The best way to prevent cold and flu is to avoid contact with sick people and frequently wash your hands. Vitamin C is an immunity booster, not an immunity builder. Proper nutrition, healthy lifestyle, good hygiene are the building blocks for good health. Not an isolated supplement!

New York City bans bake sales in schools

Would banning bake sales from schools solve the childhood obesity problem? New York City regulators seem to think so! They seem to be on a roll because in their zeal to impose a wellness policy, they are going after everything they can find which can be labeled as nutritionally evil for the health of our children. This is nutritionism at its best without regard to the cultural norms.

You might be wondering why it bothers me so much! After all, I don’t live in New York City and my children are too young to go to school.

What I find troublesome is that regulators and policy makers feel that simply by making new rules and demonstrating their power, they can change unhealthy behaviors. It is only the stick, never the carrot! In this case, everybody is rightly upset that they will lose a very traditional way of raising funds for school activities. But are the regulators providing any alternative? A few exceptions to the new rules are provided, but they are practically useless in terms of fundraising.

They should try to focus on encouraging children to make the right choices about their eating habits in the long run. Not simply ban stuff without providing alternatives.

Parents magazine offers tips for turning your baby into a veggie lover

Dr Greene, the author of Feeding Baby Green, has a nice article in the November issue of the Parents magazine. He advises to build on your child’s curiosity about colorful things by introducing him to colorful fruits and veggies. Start early, keep trying,  and introduce variety right from the very beginning. A lot of parents are concerned about allergies, so they do not introduce new foods quickly. He disagrees with this approach and offers scientific data which suggests that babies learn to love new flavors best when they are introduced to new foods in rapid succession. He gives you a nice list of 21 plant families you should sample with your child before he reaches the age of 1.

It may work, or it may not work – and of course, all bets are off in the toddler years! That is when they get picky and nothing seems to work anymore. Here are a few articles we have published to help you with fruits and veggies:

Ask the Expert – Developing a Taste for Fruits and Veggies
Help! My Kids Don’t Eat Enough Fruits and Veggies
Ask the Expert – Getting Complete Nutrition on a Vegetarian Diet
Help Your Child with Autism Have Fun with Food

Enjoy and do let me know you think. I would love to have you share your best tips in comments below.

Photo source -tomhe on Flickr via everystockphoto
©2009 Littlestomaks.com

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Let us admit it – we love our hamburgers! No barbecue party is complete without grilling burgers, the smoke filling the air as you enjoy a couple of beers with friends gathered around the grill. McDonald’s serves millions of hamburgers each day. And if you include other fast food outlets and restaurants, the total number would probably reach tens of millions every day. If we had one, you could say the hamburger has become our national food!

When we eat a hamburger, getting sick is probably the last thing on our mind. It is cheap, readily available and tastes good. Yet, 8000 people have become sick by eating contaminated beef in 16 E. coli outbreaks in the last 3 years. The number may seem small given the very large amount of ground beef produced and consumed in the United States. But what if you or your child is the one getting sick next time. What if it makes you so sick that you have to be put into a coma and when you come out of it, you cannot even walk because you are paralyzed from the waist down. Shocking, I know, but that is what happened to 22 year old Stephanie Smith according to a recent New York Times story.

What is inside that packet of ground beef or ready-to-cook beef patties that can make you so sick?And how come we cannot test for the nasty E. coli bacteria so the contaminated meat does not reach the store shelves?

Ground beef is made from a lot of different cow parts and trimmings from a lot of different cows. In her book Safe Food, Marion Nestle cites a study which says that 1 pound of ground beef can contain meat from more than 400 cattle! The New York Times article E. Coli Path Shows Flaws in Beef Inspection describes in detail how different raw materials from far flung slaughterhouses end up at a meat processor’s plant, usually without any testing. The final product is supposed to be tested for contamination, but there is no guarantee that everything will be tested before shipping out. Usually it is too late before contamination is detected. Although there is a product recall to protect customers, some do end up getting sick. And then it is not possible to trace the source of contamination because of too many different ingredients from too many different suppliers.

Clearly, the system is broken and something needs to be done. But no one has any smart ideas for a real fix. Not a surprise that most people are looking up to the Government. I hope you are not going to wait around for that to happen anytime soon!

Here are a few things you can do to safeguard your family’s health:

• Buy from a reliable store with high safety standards. Costco is taking several steps to ensure that the ingredients are tested before meat is ground.
• Ask the store manager about their safety record, sanitation and hygiene practices. Ask if they do any testing within the store.
• Do not buy ready-to-eat frozen patties. Go for the freshly ground beef packaged at the store. Check the expiration date to get an idea of how long the meat has been sitting in the store.
• Follow safe handling procedures. Cook thoroughly to ensure the inside temperature reaches 165 ºF measured by a meat thermometer. A word of caution – a recent NYT video Hamburger Confidential shows that these instructions are not sufficient to completely remove the risk of contamination.

But I think the best tip is what I tried this week after reading about it somewhere:

• Select your favorite beef cut and ask the meat department to grind it for you. I tried this at our local Publix, and they were happy to do it. This way, you will know exactly what is going inside your ground beef.
• You can also buy a meat grinder and do at yourself at home! We have not done it yet – but I read about it in Matthew Amster-Burton’s book Hungry Monkey – could be a lot of fun operating it with your toddler!

I will not say that you should stop eating red meat because it is not very healthy and it is known to increase the risk of cancer. Moderation is the key; after all there is no reason to give up enjoying a juicy burger once in a while. But when it comes to food safety, all it takes is just one incident to make your life miserable.

I would love to hear your ideas and tips for keeping ground beef safe.

©2009 Littlestomaks.com
Photo source: rick on Flickr via everystockphoto

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Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Victoria Retelny explains why omega-3 is important for growing children and suggests a few food sources of these essential fatty acids.

Question: Is Omega 3 proven to be helpful for children? Can you recommend a few good sources and brands of Omega 3?

Answer:

Yes, omega-3 fatty acids, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are found in breast milk, are beneficial for children’s normal growth and development.  For infants, DHA has been found to be vital for visual and brain function and development.  Some research has shown these essential fats to help children with attention deficit & hyperactivity disorder (ADHD). As children grow into adults, there is evidence that omega-3s are a great way to keep the heart healthy, too.

As always, food sources should be the first choice for your child’s diet.  Omega-3 fatty acids come from two sources: plant foods like walnuts, flaxseeds, tofu, soybeans, and canola oil, which contain alpha-linolenic acid (ALA) and fatty fish, which contain both DHA and EPA.  Some of the best fish sources of omega-3s are salmon, albacore tuna, lake trout, mackerel, and herring.  Since some fish can be high in mercury and other contaminants, there are limits to how much children (and adults) should eat.  According to the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency, up to two average fish meals or 12 oz per week – is safe for children.  Since albacore tuna is higher in mercury than chunk light tuna, limit the serving to 6 oz. per week.

The types of fish that children (and adults) should avoid due to high mercury levels:

• Shark
• Swordfish
• King mackerel
• Tilefish (Golden bass)

The Dietary Guidelines for Americans 2005, advise people to check local advisories to learn about the safety of fish caught in nearby local lakes, rivers, and coastal areas. Advisories may recommend that people limit or avoid eating some types of fish caught in certain places. If no advice is available, young children may eat up to 1 meal per week of fish from local waters, but no other fish during that week.

The U.S. dietary supplement market is exploding with omega-3 capsules. Use caution, particularly with young children, when giving supplements – of any type.  Dietary supplements are not regulated by the federal government.  According to the FDA’s Web site, supplements ingredients may be reviewed for safety, but not effectiveness.  The ultimate responsibility for product safety is on the manufacturers and distributors before the supplements reach store shelves. The FDA will step in if products are found to be unsafe or if they contain false or misleading claims.

So what are good sources of omega-3s for children?  The best sources are fish and “designer” foods like omega-3 fortified cereal, yogurt and eggs.  Although, a recent article in Journal of the American Dietetic Association states that there is no specific recommendation for EPA and DHA individually right now, the need to get a balanced diet that includes essential fatty acids like omega-3s is important, particularly for growing children.  As always, consult a physician before giving fish oil capsules to children under 18 years old.

References:
Kris-Etherton P, Hill AM.  n-3 fatty acids: food or supplements?  J Am Diet Assoc (2008):108(7);1125-1130.

US Food and Drug Administration, Dietary Supplements: What You Need to Know.

Omega-3 fatty acids, fish oil, alpha-linolenic.  The National Institutes of Health, Medline Plus.

Dietary Guidelines for Americans. MyPyramid for Preschoolers.

©2009 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

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This post is part of the Attachment Parenting Month 2009 blog carnival, hosted by Attachment Parenting International. Learn more about how you can stay “Attached at the Heart Through the Years” by visiting API Speaks, the blog of Attachment Parenting International.

This also happens to be my 200th post on Littlestomaks. So I am doubly excited!!

I don’t characterize myself as an AP parent, but I do subscribe to their 8 principles of parenting. I read the API Speaks blog regularly. It is fun to read the experiences of Moms so passionate about the principles of attachment parenting. Not usual to find Dads writing or commenting on this blog, so I feel a little strange writing a post for the AP month 2009 blog carnival. Yet, just like my wife, the bond I feel with my twins is incredibly strong and it begins with the heart. Never before in my life, have I felt the kind of emotions I feel when I look into their eyes, enjoy their abundant smiles, feel the frustration of their tantrums. Incredible it may sound – or maybe not – this Dad is attached!

You see, Dad’s are funny creatures. Straddling the wide gulf of expectations of being tough on one side and being gentle and nurturing on the other, they try their best not to let their children and their spouse down. The heart doesn’t show itself too often in their actions, but it does beat the same way as a Mom’s and does melt at the sight of their children.

Anyway, I digress.

The theme of the AP month this year is to celebrate our growth as parents as we face the challenges of transitions in our children’s growth. Talking of transitions – our twins turned 3 this year, so we have gone through a lot in a very short period of time. So, I love this opportunity to share with you our experience and a few lessons we have learned along the way.

My son loves to go around the block with me on his tricycle. It was easy in the beginning – he would stay on the sidewalk and ride along the short circular loop around our house. Over the last few months he has grown more adventurous and curious about every small thing along the way. It is fun to watch him get off his tricycle to carefully examine the line of ants crossing the sidewalk. “Fireants! It will bite me” he shouts, remembering the time when a couple of them climbed through his sandals and bit him on the foot. He loves to climb on top of the cable boxes pretending to be on a train. Another favorite is stopping by the electrical utility boxes and trying hard to take a peek inside to see if the “electric monster” is awake! The warning label on the box shows a big electric arc in the shape of a monster hitting a child and throwing him to the ground. He knows to stay away and not climb on top of this one. “The monster will hit me and make me fall” is what he repeats to himself – not out of fear or panic, but in an attempt to register the dangers of electricity shown on the label. He is equally fascinated by the “shuttles” (airplanes) in the sky and dog poop (yikes!) on the ground! He imagines the monsters inside the wooded areas next to the sidewalk which he calls a jungle, and tries to get closer to the trees inch by inch each day.

Quite clearly, our walks around the block are not linear anymore. They are full of adventure, curiosity and story-telling. They are a stop-and-go most of the time unlike the slow, continuous riding of his early months. Sometimes he barely moves, and sometimes he pedals so fast I have to run along to stay by his side.

Although challenging, these walks have given me a chance to reflect upon a few simple parenting lessons:

Safety first – he loves to push the boundaries each day, but when it comes to safety, there is no compromise. My voice gets sharp and the tone high pitched as I command him to get back on the sidewalk when he tries to get on the road. Sometimes, I have to physically move him back on the sidewalk even if he kicks and screams. Staying calm, firm and decisive is key. Slowly he is learning that watching out for incoming cars is important, and so is getting away from the dogs even though their owners keep them on a leash!

Talk is cheap – which is why we do a lot of it on our walks! We talk constantly – he makes a statement, which I repeat in the same tone; he asks a question, which I answer not necessarily in a logical way; I ask a question which he answers definitely not in a logical way. If I were to record our conversation, it would seem at the edge of reason and bordering nonsense! He is crazy about trains, so everything boils down to engines, freight cars, signals, bridges and railroad crossings. I have been trying to talk him into writing a letter to Santa this year asking for a bag of a hundred train toys!

Be present – is probably the most important lesson. There is nothing between the two of us on these walks. No thoughts of work, meetings, deadlines; no thoughts of hanging out with friends to watch football while enjoying a beer; not even thinking about the topic of the next blog post. I do not carry my Blackberry with me; for an hour or so, there is nothing between the two of us.

Nothing is too small or ordinary – ants, dead bugs, mailboxes, cable boxes, sheriff’s parked car, sprinklers, speed bumps in the road, sound of traffic in the distance, dog poop along the road, planes in the sky and jet-skis parked in an open garage! Everything is extraordinary in my son’s imagination and he pauses for a moment to soak in the experience of everything big or small. All the senses are at their peak; being present in that moment is almost like meditation. I am learning to see the world from a child’s eye where everything is extraordinary!

Leash of love – is what keeps it all together. I know it makes you think of walking a dog, but I like to think of it as flying a kite. The line needs to have the right tension depending on the winds and how high you want it to fly. Too much tension and it will break and fly away; too little and it will sink to the ground. Love lets you get to the right tension in this invisible line. It comes by trial and error, but you will know.

Enjoy the joys of parenthood. Feel free to share your thoughts in your comments below.

©2009 Littlestomaks.com

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