Q: I have four children between the ages of 3 and 14 years, and all of them are picky eaters. I am concerned that their inconsistent eating habits may cause harm over time. Out of frustration, I have been using daily multivitamins for all of them. My friend told me that whole food supplements would be a better choice. Is this true?
A: I see many parents on a daily basis who are concerned that even though it may be a stage for children to be very picky in what they eat, there is always the possibility of insufficiencies that may develop over time. Nutritional deficiencies are not common in North America and it's true that poor eating habits may be just a stage for some children. However, insufficiencies are increasingly common as we consume more and more processed foods.
Most parents know that eating real food is the ideal - as much as they know the sun rises in the east. But what is a parent to do when all kinds of measures have been tried from attending classes on how to get your child to eat, to reading books on how to sneak healthy foods into these selective eaters? I have noticed over the years that most parents resort to daily multivitamins because they have been told by well meaning, but ill-informed, experts that, "It is extra insurance and taking multivitamins cannot hurt". This is simply not true anymore as science increasingly questions the value of multivitamins.
What makes multivitamins so attractive is the relative affordability, the simplicity, the convenience, and the marketing, which all leads to a false sense of security. Families are busy and many parents are looking for magic bullets and quick fixes. Nobody enjoys food fights day after day.
Dr. David Katz from Yale Medical School, a well-respected expert in the field of preventive medicine, recently explained on NBC's TODAY show why taking vitamins cannot make up for a suboptimal diet. The key points to remember are that:
- Vitamins are isolated products, manufactured by man. They do not work as well in synergy compared to whole foods such as unprocessed fruits and vegetables. (One can use the analogy of produce working like a united ensemble of players in a symphony orchestra, as opposed to vitamins which would be like putting together musicians of a jazz band, members of a rock band, and symphony players – and expecting the music to be complementary.)
- Vitamins have been shown in some studies to increase the risk of cancers as opposed to reducing it. (A number of studies have caused concerns that vitamin supplements may even raise the risk of some cancers over time. Though the risk is small, it is important to be aware of those studies while we await further research.)
- Isolated antioxidants (such as beta carotene, Vit C and Vit E) in multivitamins at first showed much promise, especially in the athletic population. However, when compared to whole food supplements, their benefits are increasingly questioned as we get more and more evidence-based research confirming that whole food supplements should be chosen over multivitamins.
What are whole foods? It is food that is unprocessed and unrefined or it is processed and refined as little as possible before being consumed. It typically does not contain added ingredients such as sugar, salt, or fat. The term may be confused with organic food, but whole foods are not necessarily organic; nor are organic foods necessarily whole. Great examples of whole foods are fruits, vegetables, and whole grains.
One of the least controversial food groups are fruits and vegetables. Few Canadians eat the recommended 5-10 servings daily. In fact, research shows that with even the best efforts - such as involving dietitians, frequent reminders, using blenders or juicers, increasing portions, getting families to plant their own produce all year round - only 30% of families ingest the daily recommended intake.
Given it is so hard to consistently consume fruits and vegetables all year round, some families have chosen to give their children whole food fruit and vegetable supplements instead of multivitamins. The good news is there is data to show that as a result their children have less cold viruses, miss less school, have fewer visits to doctors, and need less prescription medications. (See www.childrenshealthstudy.com.)
Researchers from the University of North Carolina published data in the journal Medicine and Science in Sports and Exercise (Vol 38, No 6, June 2006) which showed that multivitamins may not be the best choice when compared to whole food supplements. When compared to antioxidant vitamins, whole food supplements used in athletes who engaged in intense aerobic exercise provided better protection against oxidative stress. Many parents and coaches find their adolescent athletes eat poorly when they travel for long distances to various sporting events. I have made it a habit to encourage these families to consider whole food supplementation unless they can consistently consume real food each and every day of the year - few can.
The bottom line is that we may be continuing to overestimate the benefits of daily multivitamins. While more and more research supports the use of whole food supplements, your grandmother was still right: eat real food. To get more vitamin C, eat broccoli or oranges; for Vit E, consume almonds or peanut butter; carrots and spinach will give Beta-carotene; for folate, consume beans and asparagus; B6 can be obtained from potatoes and bananas; B12 is provided when we eat fish and beef.
One vitamin supplement that is the exception is Vitamin D3. It is a key vitamin backed up by study after study as one to supplement with. In Calgary, given our location is quite north, my advice is to use 1000IU of D3 between September and April. For more data on its use, see www.healthykids.ca.
To see the interview with Dr. Katz on national TV, visit www.healthykids.ca and follow the link under "Featured Resources".
Dr. Peter Nieman is a parent of four children. He is the founder of www.healthykids.ca and the co-founder of the Pediatric Weight Clinic. Dr. Nieman is a Clinical Assistant Professor at the University of Calgary, a member of the Canadian Pediatric Society and the American Academy of Pediatrics. He has completed 71 marathons towards his lifetime goal of running 100 marathons.
Access www.healthykids.ca for a terrific new resource in helping families raise healthy children - HealthyKids with Dr. Nieman will optimize your child's complete health.
An informed parent is ... an empowered parent.