Can better nutrition help small kids grow faster?

Q.  I have a 10 year old daughter who is small for her age and wants to grow and gain some weight. She eats well when she likes what is on the table, however she is kind of picky. She does not care for meat and doesn't eat many vegetables. She loves fruit and would live on pizza if we let her. She takes a multi-vitamin every day. I don't know what to do that would be healthy for her and help her grow. Should I give her a nutrition drink supplement?

A.  First, don't worry too much about your daughter's picky eating habits. It's very common for kids to shun vegetables in favor of pizza and still grow up strong and healthy.  Keep on doing what you can to encourage healthy eating habits without turning the family dinner table into a battle zone.

The truth is that your daughter's height is probably not a nutritional issue. Severe malnutrition can result in poor growth, but I'm fairly certain that this is not the case with your daughter.  Short of growth hormone injections (highly controversial) there's not too much you can do to affect her height, which is genetically programmed.

If, on the other hand, your daughter is underweight, getting more calories into her will help her gain weight.  Foods that are calorie-dense as well as nutrient dense can help. Whole milk, full fat yogurt and cottage cheese, cheese, peanut butter, dried fruit, and nuts are all nutritious, calorie-dense foods that she might enjoy.

I'm not a big fan of nutritional supplement drinks. They're usually very high in sugar (high-fructose corn syrup) and the vitamins and minerals they provide are all found in a multi-vitamin, which she's already taking. I think she'd be better off getting her calories from real food!  You could experiment to see if you can come up with a healthy "milkshake" to supplement her calorie intake. Try some whole milk, frozen bananas, cocoa powder, peanut butter, and a little honey.

Here are some more resources for you to explore.

Growth calculators. Here are a series of calculators that show you how your child's height, weight, and body mass compare to the norms. And here is a calculator that shows you a healthy weight for a child of a certain age and height.

Nutrition for Kids. Here are some previous posts on getting kids to eat healthy, getting kids to eat more vegetables, a recent episode of my weekly podcast focusing on kid's nutrition, and a n interview I did on the Ben Greenfield Fitness Podcast on the subject of kids, nutrition, and obesity

Calorie-dense foods. When you look up foods on ND, you'll see our Nutritional Target Map, which shows you how nutrient dense and how calorie-dense every food is.  Foods for healthy weight gain are those that are both, and they'll map in the lower right hand corner of the map.

People looking to lose weight usually want to select foods that fall in the upper right hand corner of the Nutritional Target Map. These are foods that are nutrient dense but not calorie dense.

For more on how to use the Nutritional Target Map, see our help page. Here is our Nutritional Map Search Tool.

Reality Check: Does candy turn kids into monsters?

Trying to rein in the amount of sugar kids eat is hard enough.  Having a plastic pumpkin full of candy in the house sure doesn't make it any easier.

There are plenty of compelling reasons to limit kids' intake of sugar. Candy is a source of empty calories that can displace more nutritious foods, lead to weight gain, and wreak havoc with insulin metabolism. (Type 2 diabetes used to be called Adult Onset Diabetes, but no more.)

But many parents are also convinced that sugar turns kids into little monsters--making them hyper-active, aggressive, or otherwise unmanageable. Yet the research fails to bear this out.

Is it all in parents' heads? 

Controlled studies have measured the effects of sugar consumption on behavior and cognitive performance and failed to find any connection. See for example this meta-analysis. There have even been interesting studies where parents were asked to observe kids behavior. When the parents thought the kids had eaten sugar, they reported changes in behavior--even when the kids had actually been given a placebo. See this article for more on the sugar-hyperactivity myth.

Just last month, there was an interesting new twist on this: Researchers found that kids who ate candy every day were more likely to be arrested as adults for crimes involving violence, as reported by AP News. The researchers hastened to add that the association is probably more complex than it sounds. It may be, for example, that individuals with poor impulse control eat more candy as kids and then commit more crimes as adults. 

What's a responsible parent to do?

Most parents settle for damage containment and try to strike a balance between nutrition concerns and letting kids enjoy this once-a-year festival. Rather than banning all Halloween candy (now who's the monster?), try to limit the amount that is collected and then dole it out slowly.  One small treat after a healthy meal isn't going to turn your kids into monsters.  Getting your kids up and moving--whether it's to rake leaves, play touch football, or even some Wii tennis--is also an effective way to mitigate the effects of a little extra sugar.  

Can yogurt protect you from the flu?

Q. I recently read about a study showing that probiotics protected kids from getting the flu. It seemed like a pretty powerful study in favor of the health benefits of yogurt, at least in kids. Do you have any recommendations for a reasonable "dose" of yogurt would be for an adult?

A. Yes, I noted that study with interest as well. The kids (about 300 of them, aged 3 to 5) were taking probiotic supplements or placebo pills twice a day. The kids getting the probiotics had about half as many fevers, coughs, and runny noses, took fewer prescriptions and missed fewer days of school.

We should note that the study was funded by a company that makes probiotic products.  That said, the results were published in a peer-reviewed journal (Pediatrics) so the study design apparently passed muster.

There's no RDA for probiotics for kids or adults so it's hard to say what a good"dose" might be. Most probiotic supplements contain 10 to 20 billion active cultures per dose at the time of manufacture. Yogurt that carries  the "Live and Active Cultures" seal is certified to contain at least 100 million cultures per gram at the time of manufacture, which translates into about 22 billion live cultures in an eight ounce cup of yogurt.

So, I'm thinking that a single serving of yogurt every day would be a reasonable start for kids and adults. But the amount of sugar (often high fructose corn syrup) in sweetened yogurts is shocking. I'd advise you to steer clear of sweetened (and artificially-sweetened) yogurts and go for the plain yogurt. Sweeten (if you must) with fruit or a drizzle of honey.

Can yogurt protect you (or your kids) from getting the flu this season? Might help and can't hurt (unless you're lactose intolerant).

Seven out of ten kids have low vitamin D levels

A new report reveals that 70 million American kids (ranging in age from toddlers to teens) are at increased risk of heart disease, diabetes, and bone problems due to deficient or insufficient levels of vitamin D.  Low vitamin D levels are about 6 times more common in young black Americans because darker skin produces less vitamin D when exposed to sunlight. See also this story in the Washington Post.)

This storm has been gathering for quite some time.  Vitamin D levels in adults are also low and vitamin D deficiency is being linked to an increasing number of serious, chronic conditions and auto-immune diseases. (See also my post "Vitamin D. Now I'm a believer").

Everyone seems to agree on what's causing the problem. We spend less time outdoors, we've been drilled by dermatologists (and cosmetic companies) on the use of sunscreen to protect our skin against skin cancer and premature aging. We (and our kids) get a lot less vitamin D from our diet, chiefly because we drink less milk and more soda than we used to.

(Milk does not contain vitamin D naturally, of course. It's fortified with vitamin D. Fish are the best natural sources of vitamin D.)

It's harder to agree on the solution.  Some argue that high dose vitamin D supplements are the answer. It's a logical leap, but it's still a leap. While we have evidence linking low vitamin D levels to many diseases, there's less evidence to prove that taking vitamin D supplements reduces those risks.  (Correlation does not equal causation.)

It also takes a heck of a lot of vitamin D supplementation to correct a vitamin D deficiency. While the current RDA for vitamin D is 400IU, it can take 10,000 to 50,000IU a day to replenish depleted vitamin D stores in the body. High doses of vitamin D have been found to be safe and well-tolerated. Nonetheless, many experts are wary of this kind of super-high-dose supplementation without medical oversight.

Exposing the unprotected skin to sunlight is a much more efficient way to raise vitamin D levels in the body, but it proves very difficult to make recommendations about how much sunlight a given person needs. It depends on how much skin is exposed, your latitude, your altitude, the time of day, the time of year, atmospheric conditions, and your skin color. (Yikes!).  Plus, you have to weigh the benefits of vitamin D production against the risk of skin cancer and/or sun damage.

Here, for example, are two very different points of view:

UV Advantage,org

SunProtection.net

For what it's worth, here's how I'm balancing the two, pending further findings. 

1. Because my face, neck, and chest have received an awful lot of sun over the years, I always apply sunscreen there to prevent further damage.

2. In the summer, If I'm going to be outside for any length of time between 10AM or 4PM in the summer, I put sunscreen on all exposed skin. Before and after those hours or during the winter, I don't put sunscreen on except if I'm going to be out for a long time.

3. I keep track of and have my doctor check any suspcious moles.

4. I take 1,000IU of vitamin D every day.

If you have children, you might want to ask your pediatrician about it at your next appointment. I'd probably ask whether he/she thinks it would be worthwhile to test your child's vitamin D levels and about guidelines for appropriate sun exposure and/or supplementation.

"Sugar-free" foods don't make a diet healthier, just lower in sugar

Q. When my daugher was diagnosed with Type 2 diabetes a year ago, I bought every sugar-free thing that I could for her. Now her liver enzyme levels are elevated.  I'm wondering whether the sugar-alcohols in diabetic foods may have something to do with it. 

A. Because your daughter has at least one diet-related medical concern, I hope you are working with a dietician or nutritionist. No-one can (or should) diagnose your daughter's medical issues over the internet. 

Diabetics often have elevated liver enzymes.  And to my knowledge, sugar alcohols are not generally linked to liver problems. But your letter brings up an interesting issue. You don't say how much sugar alcohol your daughter is consuming but you write, "I bought every sugar-free thing that I could."

The fact that your daughter was diagnosed with insulin resistant (Type 2) diabetes at a young age suggests that her diet may have been out of balance, containing too much refined sugar and/or carbohydrates.  If your daughter was eating a lot of sugary foods, replacing all of these with sugar-free foods could leave you with a diet that's lower in sugar but still out of balance. 

Does your daughter's diet contain fresh fruits and vegetables? Lean protein? Whole grains? Healthy fats? Or is she eating a diet of artificially-sweetened diabetic junk food? One positive step would be to replace most nutrient-poor, "sugar-free" foods with nutritious, whole foods.

Sugar-free foods have a place: they allow allowing diabetics and others who need to avoid sugar to enjoy an occasional sweet treat. But just because something is sugar-free doesn't make it good for you!  If foods processed with sugar alcohols and artificial sweeteners make up a significant portion of your (her) diet, chances are that they are displacing other healthier foods. For that reason, I recommend that sugar-free and artificially-sweetened foods and beverages be consumed in very limited quantities--just like foods containing sugar.

Kids who are able to delay gratification are less likely to be overweight

I was struck by the common-sense wisdom of this recent study, showing that 4-year-olds who aren't able (willing?) to delay gratification are about 30% more likely to be overweight by the time they are 11. 

What the authors of the study don't tackle is how (or whether) the ability to delay gratification can be taught. Is it a personality trait or a learn skill?  Studies show that, at least among college students, the ability or willingness is directly related to how important the pay-off seems. 

In other words, being willing to delay gratification isn't just about learning to wait for a reward. It requires that we are convinced that the delayed reward is BETTER than the instant reward. I can spend this $10 today, or I can sock it away in my IRA and, thanks to the miracle of compounding interest, have $100 to spend 20 years from now.  (Recent events have temporarily undermined the effectiveness of this argument but I think over the long haul it still holds true...)

I think we're all invested in getting our kids off this obesity ride we all seem to be on.  Unfortunately, a four-year-old clamoring for a candy bar is unlikely to appreciate the pay-off of not being overweight when she's in fifth grade.  Maybe even small kids can begin to learn this skill by having to choose between a small treat now or a slightly bigger treat later.

Think of all the ways in which learning to delay gratification or reward can improve our lives: if kids can learn to wait until after dinner to have a sweet, are they more likely to grow up to be people who will get their homework done before playing video games...put aside money for retirement before going on a shopping spree...go to the gym on the way home from work before flopping down in front of the TV set?

Parents, any thoughts?

Mama, don't let your babies grow up to eat fast food

Just came across a fascinating study about breast-feeding, asthma, and fast food.

The good news is that more mothers are breast-feeding these days, and breast-feeding for longer.  I'm sure they're motivated in part by all the research showing how much healthier breast-fed babies are.  One widely reported benefit is that babies who are breast-fed have lower rates of asthma later on.

But get this:  Letting your kids eat fast food when they're older appears to completely negate the benefits you gave them by breast-feeding, at least in terms of asthma protection.

More details from the study here.

Breast-feeding is a wonderful thing to do for a child's health but obviously, we need to stay committed to their health and nutrition throughout childhood!

Childhood obesity: What can you do to help?

All of us, whether or not we have children, need to be concerned about the rising rates of childhood obesity. The consequences, both to the kids and to the society that will bear the costs of a sicker population, are dire.  What are the factors contributing to this troubling trend and what can we adults do to help raise the next healthy generation?

This was the topic of a recent interview I did on Ben Greenfield's Fitness podcast.  You can listen to the interview here: http://www.bengreenfieldfitness.com/2008/12/podcast-episode-24-are-you-making-your-kids-fat.  (It starts about 20 minutes into the show.)

Avoiding peanuts may be causing more peanut allergies

In another of those annoying reversals (what? you mean butter's actually better for me than this yucky margarine you made me switch to?!?), researchers now think that keeping our kids from eating peanuts early in life may actually be causing more peanut allergies, not less.

Even if you don't have kids yourself, you've probably noticed that severe peanut allergies have gotten to be a much bigger deal lately.  The child care facility at my gym has large signs informing parents that no peanut-containing snacks may be brought in because so many kids have peanut allergies.

Last year, I was even on a flight where they couldn't serve peanut snacks because there was a child on board with a peanut allergy so severe that having a packet of peanuts open on the plane would be enough to cause a grave reaction.

If you have kids, then you've probably been told not to give your children peanuts or peanut butter before the age of nine months. Your OB may even have warned you not to eat peanuts during your pregnancy. The idea is to prevent peanut allergies.  But now, researchers have found that kids (and mothers) who eat peanuts sooner actually have fewer peanut allergies.

Isn't that ironic? Here's a link to a summary of the study and to the study itself.

The experts feel that more research needs to be done before the guidelines are revised. So check with your pediatrician before you go off-road.

Overweight kids: Researchers claim they're not eating enough

Interesting study in this month's Journal of the American Dietetic Association. Researchers analyzed the diets and health stats of low-income kids. The kids' diets were very high in fat and sugar, and low in whole foods and important nutrients like calcium, magnesium, phosphorus, and potassium.

A third of the kids were obese. But, surprisingly, when researchers analyzed their diets, they concluded that 44% weren't eating enough calories. Researcher Roberto Trevino offers the following intepretation:

"The problem is not that they're eating too much. It's that they're lacking nutrients that are important for metabolism to burn off fat and sugar."

The mainstream press seems to buy this notion, as evidenced by this headline in the San Antionio Express News: "Heavy Kids Aren't Over-Eating."  (Despite the misleading headline, this story actually gives a very good and balanced summary of the study.)

Frankly, I don't buy Trevino's explanation.  Calcium, magnesium, and potassium are certainly essential nutrients and "important for metabolism" in the most general sense. But they don't specifically "burn off fat and sugar."  That sounds a little too much like those miracle weight loss supplements sold on late-night infomercials. 

Can't you just hear it now: These miracle nutrients turn your body into a fat-burning machine!

No, obviously, if these kids were overweight, they were eating more calories than they needed.  I think the true explanation is two-fold:

1. The kids were sedentary and therefore needed fewer calories than researchers estimated that healthy kids would need to grow.

2. The kids ate more than they told the researchers they did. (This is typical of self-reported food intake.)

What this study clearly shows that low-income kids are eating poorly and suffering because of it. Not only are a third of them obese, but 7% are already at risk of diabetes. But to suggest--as these researchers seem to be suggesting--that they're eating too few calories and getting fat anyway because of a lack of minerals which "burn off fat and sugar" seems ridiculous and even dangerous to me.

What do you think?