logo-choose-my-plate-170x155Yesterday, on The PediaBlog, I wrote that good nutrition starts at birth.  But actually, it starts before birth.  Science has shown that the risk of neural tube defects — like spina bifida — is reduced when women take folic acid (vitamin B9) during pregnancy.  The authors of “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,” the editorial published this week in the Annals of Internal Medicine, probably didn’t have this special population in mind.  Nor were they thinking of children and adults who have congenital or acquired conditions and require daily supplements of specific vitamins and minerals in order to survive and thrive.

No.  I think the message of that opinion piece really is: “Step away from the Twinkie and eat an apple instead.”  In other words, if you are getting your vitamins and minerals in your food every day, there really is no reason to take a synthetic multivitamin.  After all, we weren’t born with a bottle of vitamins attached to the placenta.

For the most part, that message is the correct one.  The question then is:  Is our diet “nutritionally sufficient?”  And if it is, then why take vitamins?

Few parents think their kids are great eaters.  A lot of parents think their kids are terrible eaters.  In fact, I’d say (as a pediatrician and a father) that being picky is the norm, especially in young children.  (Read this PediaBlog post.)  I know a few (not many) very picky adults, which tells me that the mind opens and pickiness improves in later childhood.  As a pediatrician, I keep my expectations low (certainly lower than as a father!).  If my patients are eating three times a day, their parents are serving a healthy balance of real (not processed) foods, the kids are happy and active, and, most importantly, are growing well and consistently on their growth charts, and they’re healthy, then I’m happy.  In these cases, I may or may not recommend a vitamin supplement, depending on the specifics of the diet.

What thrills me is when children (and their parents) eat a lot of fruits and vegetables every day, have a steady and reliable source of calcium (usually dairy) to attain the recommended daily requirement, and have a reliable source of daily protein (lean meats, peanut or almond butter, and beans (legumes)).  Processed foods (anything in a package with more than two ingredients — especially those that sound like they belong in a chemistry lab and not in our stomachs) should be avoided whenever possible.  If the food in your hand does not look like it grew on a tree or bush, or came from an animal you can readily identify, you can bet it’s processed.

Oh, and I want a child’s beverage-of-choice to be water.  (Infants should choose breast milk or formula.)

Is that asking too much?  I say no.  Plenty of children would disagree, however, and we need to understand that.  One of the worst things we can do as parents is to force our kids to eat what we want them to eat.  It doesn’t work, and it will surely close their minds further.  (Read more PediaBlog on this topic here.)  They’re allowed not to like the healthy foods we serve them.  Serve them anyway!  Don’t fight with them.  You’ll never win that battle.

So, back to the topic of vitamin supplements:  If a child eats well — real food, lots of fruits and veggies, enough calcium, and a reliable source of protein from real sources — do they need to take vitamins too?  If she is getting enough vitamin D in her diet (400-800 International Units per day, depending on age — easier said than done) or getting a brief, daily skin exposure to sunshine (tough in northern climates), then she may not need any vitamin supplements.

In reality, most children (and adults) do not get anywhere near their daily requirement of vitamin D.  Many children also do not consume enough calcium, either.  Kids who don’t eat fruit probably don’t get enough vitamin C.  Picky green vegetable eaters may not get enough B vitamins.  Picky meat eaters may not get enough B vitamins and iron.  In all these cases, pediatricians will recommend at least a vitamin D supplement and, at most, a daily multivitamin.  Teenage girls will probably want some iron in their multivitamins.

We don’t recommend “mega” doses of vitamins.  Huge doses of vitamins and supplements are not necessary for most people. Besides, they can be dangerous.  More on that tomorrow.