The ABCs of Pediatric Multivitamin/Multimineral Supplements

Parents and caregivers need help selecting appropriate supplements, which should be used as adjuncts to a balanced, healthy diet.

Yvette C. Terrie, BSPharm, RPh

Courtesy PharmacyTimes.com 

Published Online: Thursday, August 1, 2013 

Parents and caregivers need help selecting appropriate supplements, which should be used as adjuncts to a balanced, healthy diet.

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Many parents and caregivers choose to give the children in their care multivitamin/multimineral (MVM) nutritional supplements to ensure that they obtain the recommended essential nutrients, to promote overall health, to increase nutrient intake, and to decrease the risk of disease.¹

Overall, approximately 1 out of 4 children take an MVM supplement or some type of nutritional supplement, although adolescents are least likely to take these supplements.¹ However, a 2009 study found that children who are at greatest risk for nutritional deficiencies are least likely to use nutritional supplements.^2-4 The study found that children who are more active, healthier, eat a balanced diet, and have better access to health care are more likely to take MVM supplements and that vitamin usage was highest among 2- to 4-year-olds and lowest among 12- to 17-year-olds.^2,4

Other studies have demonstrated that the majority of children typically meet the recommended intake of essential nutrients through dietary means alone.^1-4 The American Academy of Pediatrics (AAP) and the American Dietetic Association emphasize that eating a balanced, nutritious diet is the optimal method of obtaining essential nutrients.^2-4 The AAP does not recommend nutritional supplementation in healthy children over the age of 1 year. Nonetheless, pediatricians may recommend supplementation if a child is underweight, is a picky eater, is on a restricted or special diet (eg, a vegan diet), or has a medical condition that may increase the risk of nutritional deficiencies.^1-4 For example, a child on a dairy-free diet may require calcium supplementation, and a child on a vegetarian diet may require an iron supplement.

There is also ongoing concern about the number of children and adults with low levels of vitamin D. Recent studies have found that approximately 70% of children in the United States are not getting sufficient amounts of vitamin D and that an estimated 9% are vitamin D deficient.^5-7 Study results also indicate that vitamin D deficiency is particularly prevalent among overweight and obese children.^5-7 The AAP and the Institute of Medicine (IOM) recommend a daily intake of 400 IU of vitamin D during the first year of life beginning a few days after birth, and a daily intake of 600 IU for everyone older than 1 year.⁸ These organizations further recommend that parents and caregivers consult their pediatricians regarding their children’s vitamin D needs to ensure optimal levels are being met.⁸ Due to concern about vitamin D deficiencies in children, the vitamin D content of many MVM supplements has been increased in the past few years in accordance with recommendations from the AAP and the IOM. Other studies have found that many boys (aged 9 to 13 years) and girls (aged 9 to 18 years) do not obtain enough calcium from their diets.⁹

Nutritional Supplements

MVM supplements designed for children are available in chewable, gummy, gumball, and liquid formulations. In addition, single-entity products are available that may be beneficial for those who are deficient in just 1 nutrient, such as vitamin D or calcium. There are also liquid nutritional supplements such as Pediasure (Abbott) that provide children with protein, fat, fiber, and a combination of vitamins and minerals to aid in growth and promote weight gain.¹⁰ Parents should be encouraged to discuss the use of liquid nutritional supplements or MVM supplements with their pediatrician to ascertain which is the best option. MVM supplements for children may include omega-3 fatty acids for healthy brain development and heart health, extra vitamin C to promote immune support, as well as iron, calcium, zinc, vitamin D, the B vitamins, and vitamin E, which are all nutrients children are most commonly deficient in.⁷

In addition to the typical children’s formulations, Bayer Healthcare markets the One A Day Teen Advantage line of vitamins specifically designed to meet the nutritional needs of teenage boys or girls. The formulation for teen girls contains extra iron, which helps prevent iron-deficiency anemia during menstruation, while the teen boys’ formula contains nutrients to promote muscle function and growth. In addition, Bayer has introduced a new line of Flintstones MVM supplements for toddlers in both chewable and gummy formulations. The company has also introduced a new formulation of Flintstones Complete Vitamins by adding more vitamin D to the supplement. Other popular brands of children’s multivitamin supplements include Centrum Kids (Pfizer Consumer) and L’il Critters Gummy Bear Supplements (Northwest Natural Products, Inc).

Conclusion

MVM supplements should always be kept out of reach of children to prevent accidental overdose, which is particularly important because nutritional supplements can easily be mistaken for candy. Parents should remember to only give children the formulations that are marketed for use in children and to administer no more than the recommended dosage; excessive doses, especially of fat-soluble vitamins, can cause toxicities. Because children are increasingly being prescribed medications to treat conditions such as asthma, diabetes, allergies, and attention-deficit/hyperactivity disorder, pharmacists should screen for possible contraindications and drug interactions before recommending supplements.

During counseling, pharmacists should advise parents and caregivers that nutritional supplements are intended to be used as adjuncts to—not substitutes for—a balanced, healthy diet. Parents and caregivers should also be reminded that these supplements are intended to prevent nutritional deficiencies and to maintain nutritional stores and are not intended for self-treatment of vitamin deficiencies. Patients exhibiting signs of nutritional deficiencies should always be referred to their primary health care provider for proper treatment. Pharmacists should also check for possible therapeutic duplications to prevent possible toxicities, especially involving fat-soluble vitamins and iron. Pharmacists can be instrumental in assisting parents and caregivers in the proper selection of nutritional supplements and in identifying possible drug-micronutrient interactions and contraindications. If there is any doubt regarding whether supplementation is needed, parents should be encouraged to discuss the use of MVM supplements with their pediatrician. It is especially important to remind patients that there is no substitute for eating a balanced, healthy diet to ensure the overall health of their child.

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Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

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Resources
For more information on MVM supplements and dietary guidelines for children, please visit the NIH Office of Dietary Supplements website at http://ods.od.nih.gov/factsheets/list-VitaminsMinerals/.

References

1. National Institutes of Health Office of Dietary Supplements. Multivitamin/mineral supplements. http://ods.od.nih.gov/factsheets/MVMS-QuickFacts. Accessed June 3, 2013.
2. Moreno M. Advice for patients: vitamin and mineral supplementation in children. Arch Pediatr Adolesc Med. 2009;163(2):192.
3. Science Daily. Vitamin use is highest in kids who don’t need them, study finds. http://www.sciencedaily.com/releases/2009/02/090202174657.htm. Accessed June 4, 2013.
4. Ulfat S, 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;163(2):150-157.
5. CCNhealth.com. Vitamin D deficiency common in U.S. children. www.cnn.com/2009/HEALTH/08/03/vitamin.d.children. Accessed June 3, 2013.
6. Turer CB, Lin H, Flores G. Prevalence of vitamin D deficiency among overweight and obese US children. Pediatrics. 2013;131(1):e152-e161. http://pediatrics.aappublications.org/content/131/1/e152.abstract. Accessed June 3, 2013.
7. Peaslee K. Supplements: nutrition insurance for children. Today’s Dietitian. www.todaysdietitian.com/newarchives/tdjan2008pg50.shtml. Accessed June 5, 2013.
8. American Academy of Pediatrics. Kids and vitamin D deficiency. www.aap.org/en-us/about-the-aap/aap-press-room/pages/Kids-and-Vitamin-D-Deficiency.aspx. Accessed June 6, 2013.
9. NIH Office of Dietary Supplements. Calcium. http://ods.od.nih.gov/factsheets/Calcium-QuickFacts/. Accessed June 3, 2013.
10. Abbott Laboratories. Pediasure [product information]. http://pediasure.com/kid-nutrition-products. Accessed June 4, 2013.

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For more information about children''s multivitamins, please visit www.kidshealth411.com.

 

Are Vitamins Good For You?

This article was originally written about a year ago on a different blog site...at the time, there were numerous articles being released that multivitamins caused more harm than good. Since then, there have been other studies showing the opposite.  Bottom line, each person must make the best decision for him/her based on information available and common sense.  I am reposting this because I still feel the information is relevant.

Are vitamins good for you?

Phillip A. Black
December 2011

Over the past several weeks, I have read numerous articles and blogs on the topic of vitamins (and supplements) and if they are good for you or not. Almost all of the articles, no matter what credentials the authors do or do not have are simply rubbish. Period. End of story. Why would I make that statement? Because EVERY article I read about this topic contains the same fatal errors. The authors generalize and do not account for any variables. Well, it's time to set the record straight. I am going to justify why my mantra is "Eat well, exercise, and supplement intelligently."

Yesterday, I read an article written by a dietician who stated that most people under 50 do not need supplementation if they eat well. Really? How does she define eating well? I don't know because she didn't define eating well in her article. Does eating well mean following the laughable food pyramid? Does eating well mean eating only organic foods grown locally? Does eating well mean eating the types of food that our genes require for optimal wellness? Does eating well include consuming canned or frozen fruits and vegetables? The answers to just a few of those questions can make a huge difference. Ask ten people if they eat well and almost all of them will answer affirmative to some degree. Very few people will say they do not eat well. However, eating well is relative.

Most people think yogurt is a health food...and it can be. Well, if you eat organic, plain yogurt with active cultures and no added sugar, it is very healthy. However, how many people eat that type of yogurt? I see what people put into their carts at the store and it's not plain, organic yogurt. Dannon Company settled a class action suit to the tune of $35 Million regarding its Activa yogurt line. The lawsuit was filed in early 2008, alleging that Dannon knowingly misled consumers in its marketing of the yogurt. The massive false advertising campaign convinced shoppers to pay 30% more for yogurt containing “probiotic” bacteria because of the products’ supposed health benefits. You see, it's not that healthy! It contains fructose syrup, sugar, and fructose (three distinct instances of added sugar on top of the sugar naturally present in the strawberries and the lactose). The total sugar count is 17 grams per serving (just over 4 teaspoons). The three added sugars only account for one teaspoon though. This is actually not too bad, and much better than Yoplait Strawberry Yogurt that clocks in at 27 grams of sugar. What does this have to do with vitamins? Perception. People are misinformed by advertising and simply do not grasp the facts. In a perfect world, I might agree with the author's assessment that most people under 50 do not need supplementation IF they truly ate well. However, this is NOT a perfect world. Look around. How many people eat well? Obesity rates are soaring. The number of people diagnosed with Type 2 diabetes is soaring. Because of financial struggles, Americans are eating cheap, processed foods at an alarming rate. A study published in December 2007 issue of the Journal of the American Dietetic Association found that a single dollar could purchase 1,200 calories of cookies or potato chips, but only 250 calories of carrots- which may help explain why the highest rates of obesity continue to be observed among groups of limited economic means.

Where do Americans eat their food? Americans are now spending over $140 billion annually on fast food at over 25,000 fast food restaurants. Based on this statistic alone, Americans are not making solid nutritional decisions. How about a Happy Meal? A cheeseburger happy meal with fries and a soda at McDonald's has 640 calories and 24 grams of fat. This is over half of the total calories many children should be eating in a day. And that soda? It contains way too much sugar but it also contains phosphoric acid. So what? Calcium, magnesium, and phosphorus must be maintained in the proper balance for healthy bones. When too much phosphorus is in the blood, calcium is leached from the bones, causing osteoporosis. Even in citrus sodas which contain citric acid instead of phosphoric acid, calcium is needed to normalize blood pH. In a nutshell, we are overfed and undernourished as a country. Clearly, this is not a perfect world.
 
Let me take this one step further. Let's assume we have a population who chooses to eat a plant based diet. Let's take a look at the soil those plants are grown in. Almost all non-organic produce is now grown on factory farms. This means that the farms use modern production techniques to maximize production and profit. These modern means include pesticides, artificial fertilizers, and a lack of crop rotation. This means that the soil is nutritionally deficient as well as contaminated with chemicals. This is what the plants derive their nutrition from. You see, modern factory farms are paid solely on production and how nice the plants look. There is no financial incentive for nutritional value. This explains why there is a movement towards organic farming. People realize the food we are consuming is lacking nutritional value. So, even if you are eating a variety of fruits and vegetables, if they are not organic, the nutritional value is not what it once was. Donald Davis, a biochemist at the University of Texas, said that of 13 major nutrients in fruits and vegetables tracked by the US Department of Agriculture from 1950 to 1999, six showed noticeable declines -- protein, calcium, phosphorus, iron, riboflavin and vitamin C. The declines ranged from 6 percent for protein, 15 percent for iron, 20 percent for vitamin C, and 38 percent for riboflavin.

There are also a number of external reasons why people are not getting the nutrition one would expect from food. The number of people taking prescription medications, that impact the bioavailability of nutrition, is soaring. People taking certain drugs can not synthesize the nutritional value from food they eat. In other cases, the prescriptions themselves diminish the body.

• Antibiotics like penicillin and Tetracycline often cause deficiencies in B and K vitamins.
• Anti-inflammatories such as Prednisone, Medrol, Decadron and even over-the-counter aspirin can cause loss to important nutrients like Calcium, Vitamin C and Folic Acid.
• Oral Contraceptives and Hormone Replacement Therapy drugs affect the entire range of B Vitamins and can lead to low Folic Acid levels.
• Common antacids and ulcer medications impact Vitamins D and B12, as well as Iron and Zinc.
• Cholesterol drugs like Lipitor, Zocor and others deplete Coenzyme Q10, which can affect cardiovascular function and weaken the immune system.

Another fatal flaw of these articles is that the authors lump all vitamins and supplements together as if they're all the same. The premise of many of the articles I've read is that vitamins (in general) are either needed or not needed. That is way too simplistic. By vitamins, are they talking about multi-vitamins only or are they talking about the various types of individual vitamins available today (such as Vitamin A, Vitamin D, Vitamin E, etc? Are they talking about Centrum or are they talking about Isotonix® supplements? They are not all the same as you will see.

Let's briefly look at the ingredients of the popular Flintstones vitamins. They contain sorbitol, which is a sweetener, gelatin, a binding agent, natural & artificial flavors (including fruit acids), pregelatinized starch, a thickener, stearic acid, a saturated fat, carrageenan, a stabilizer made from seaweed, hydrogenated vegetable oil (soybean, castor), FD&C Red #40 Lake, a dye, FD&C Yellow #6 Lake, a dye, aspartame, an artificial sweetener, xylitol, a sugar alcohol, and FD&C Blue #2 Lake, a dye. Excuse me, but what is hydrogenated oil doing in a health product? I don't know either. Many popular vitamins sold in stores ARE JUNK and should not be consumed. However, there are brands of vitamins and supplements that do not contain binders, fillers, artificial colors, artificial sweeteners, alcohol, and hydrogenated oil. So please do NOT lump all vitamins together!!!

Because I am discussing perceptions and misconceptions, I need to lay out the facts about processed milk. One of the greatest misconceptions, or lies, is that processed milk is healthy and that it builds strong bones. Really? Yes, ask anybody, right? If you believe this, you are a sucker and have fallen victim to advertising. See for yourself. Visit The American Dairy Association and Dairy Council's website (http://www.adadc.com/) and read their mission statement. It states: "Our Mission: The mission of the American Dairy Association and Dairy Council, Inc. is to economically benefit dairy farmers by encouraging the consumption of milk and dairy products through advertising, education and promotion, to reach consumers with product benefits and advantages." They are being quite clear that they are in business to help the farmers by encouraging the consumption of dairy products through advertising. Nothing wrong with that...except you have all been conned if you think processed milk is good for you and that it helps build strong bones. The fact is that the countries with the highest dairy consumption have the highest rate of osteoporosis. According to the International Osteoporosis Foundation, the United States and Europe account for 51% of all fractures from osteoporosis and according to the United States Department of Agriculture, countries in the European Union and the United States are the number one and two processed milk consumers in the entire world. Yes, it’s true. Europeans and Americans not only consume the most processed milk, we also suffer the most cases of osteoporosis across the globe. I'm sure our friendly dietician didn't know these facts and probably feels if a person gets enough milk, supplementation (calcium, magnesium, and Vitamin D) is not necessary.

Bottom line. Based on surveys that I've personally conducted, over 70% of the population takes some type of supplementation. Unfortunately, due to the power of advertising and the lack of education, much of the supplementation is garbage and the consumer's money is wasted. When we go into a medical professional's office and survey clients, we ask them if they take any form of supplementation? If the answer is yes, we follow up with a question that asks what happens if they stop taking it- do they feel any difference? Almost always, the answer is no, they don't feel any different. At that point, we pause and ask the patients, if the supplements were working, wouldn't they feel a difference when they stopped taking them? The fact of the matter is so many people take junky supplements that they're not getting any benefit from them. Many top selling brands never even dissolve in the body. That's right. Because of the binders, fillers, and additives, the pills never dissolve. They exit the body in essentially the same shape they entered. Don't believe me? See the image below and Google the term bed pan bullets.

I could go on and on and discuss every type of supplement on the market but I think I've provided some facts and evidence that throwing all vitamins or supplements into the same pot is ridiculous and these articles generalizing supplement usage are nonsense. Some supplements are effective and some are not. Some are effective for certain populations and some are not. My belief is that, as a baseline, everyone should be taking quality multi-vitamin, Omega 3, and B-complex supplements.

For those in pain, or dealing with inflammation, I would strongly suggest a potent anti-oxidant. The most effective that I've found is called Isotonix OPC-3®. Isotonix OPC-3® is an isotonic-capable food supplement that is made from a combination of bilberry, grape seed, red wine and pine bark extracts, and citrus extract bioflavonoids, all found to be powerful antioxidants. Oligomeric proanthocyanidins (OPCs) are bioflavonoids (complex organic plant compounds) found in fruits, vegetables and certain tree barks that provide exceptional nutritional benefits to the human body. Studies have shown OPCs to be up to 20 times more powerful than vitamin C and 50 times more powerful than vitamin E in neutralizing free radicals.

Phillip along with his wife Beth, own Orlampa Enterprises, Inc. OEI specializes in helping people lose sickness and find wellness. Phillip and Beth also work with health care professionals to implement holistic wellness programs into their existing practice with the goal to educate both the health care provider and the patient. The programs, which provide the health care professional with a substantial additional income stream in this ever changing medical marketplace, allow the patient to achieve true wellness instead of receiving a traditional treatment for symptoms. If you are a health care provider or a patient who would like to receive nutritional counseling from your physician, Please contact Phillip at pb@orlampa.com or Beth at bb@orlampa.com or contact Beth at 727.492.8212.

Orlampa Enterprises is a privately held company based in Trinity, Florida. Contact Phillip at pb@orlampa.com for more information about independent business opportunities.

Diabetes control requires the proper nutrients

Courtesy of Natural News
Wednesday, October 24, 2012 
by: Derrell Jones

Disturbingly, diabetes kills more people in America than breast cancer and AIDS combined. The World Health Organization anticipates that by 2030, over 360 million people will have diabetes. If you wish to avoid diabetes or you currently have diabetes and wish to slow or stop its progression, then proper nutrient support is imperative. The nutrients and what foods to find them in are emphasized below.

The powerful usual suspects

B Vitamin Complex: B Vitamins are extremely important especially to diabetics but two are of particular help. Daily intake of vitamin B6 can reduce the need for insulin. Dr. John Ellis, M.D. found that a normal blood sugar level was regained when 100 mg of B6 was taken daily. Biotin, another vitamin in the complex, works with insulin in assisting the body in the utilization of glucose. Biotin is also instrumental in preventing or reversing peripheral neuropathy in diabetics. A person can find these in foods such as turkey, dark meat chicken, beef and chicken livers, mushrooms, oats, and avocado to name a few.

Vitamin C: Diabetics tend to be susceptible to infections. Vitamin C's antioxidant powers can help combat that. Also, vitamin C helps the body to form collagen which is important for vascular health delaying or preventing vascular complications. Deficiencies have led to a decreased production of insulin producing cells in the pancreas. Vitamin C can be found in foods such as broccoli, spinach, cabbage, mangoes, asparagus, cantaloupe, and citrus fruits for example.

Vitamin E: Frequently, diabetics suffer from damage to their eyes and kidneys. Vitamin E assists in preventing this damage because it is a powerful anticoagulant which reduces stress to the vascular regions of these vital organs/organelles. The following are foods which contain vitamin E: Spinach, almonds, peanuts, broccoli, mangoes, kiwi fruit and tomatoes.

Magnesium and Potassium: When the body is deficient in these two nutrients, glucose intolerance is likely. This leads to organ and nerve damage. Magnesium serves as a supporter and protector of the cardiovascular system. It helps to widen blood vessels and also reduces circulating cholesterol in the bloodstream. Potassium deficiencies can occur from the insulin support given to diabetics. Ironically, lowered potassium levels lead to poor insulin sensitivity, responsiveness and secretion exacerbating diabetic complications. You can find magnesium in nuts, seeds, whole unrefined grains, and green vegetables like spinach. Potassium can be found in bananas, apricots, dates, chicken, fish, turkey and so on.

Important but lesser known nutrients

Chromium: Whenever glucose or insulin enters the bloodstream, chromium goes right to work unless the body's reserves are low. Chromium deficiency in the average western diet means the body cannot replenish what is lost during the ordinary course of business. Add to that the fact that refined sugars strip the body of chromium adverse health conditions like diabetes is more likely. Chromium helps to normalize blood glucose levels and decreases insulin resistance. It can be found in many foods like beef liver, whole wheat or rye bread, chicken, potatoes and eggs just to name a few.

Alpha-Lipoic acid: Alpha-lipoic acid has been demonstrated to help increase the use of glucose by cells and lower insulin resistance. In fact, alpha-lipoic acid has proven to be so effective for diabetes treatment that it has been prescribed by German doctors for the last 30 years.

There are additional nutrients that are of great benefit to diabetics such as vanadium, zinc, coenzyme Q10 and essential fatty acids. Speak to a trusted healthcare provider to help create a plan that will optimize your health through proper nutrient intake.

Commentary

Although supplements are important, Orlampa Enterprises always states that a person must "eat well, exercise, and supplement intelligently."  By eating well, a person with diabetes MUST eat well. We strongly suggest that someone with diabetes understand the glycemic index of foods.  The glycemic index (or GI) measures how fast and how high blood sugar levels rise after consuming foods that contain carbohydrates. White bread, for example, is a high glycemic index food and is converted almost immediately to glucose, causing blood sugar levels to spike rapidly and potentially triggering the body to store some of the calories as fat.

Different types of carbohydrates are processed differently by the body and, consequently, have different effects on blood glucose levels. The glycemic index ranks carbohydrate-rich foods according to their effect on blood glucose levels. The best sources of carbohydrates – fruits, vegetables and whole grains – deliver essential vitamins and minerals, fiber and a host of important phytonutrients, all while having minimal impact on blood sugar.

As stated above, exercise is also a key component to obtaining optimal health.  Would you be interested in learning about a low glycemic lifestyle?  Click here.  Orlampa Enterprises helps individuals (and groups) find their fit!   

Find Your Fit Kit

Orlampa Enterprises, Inc. specializes in helping individuals lose sickness and find wellness.  

Orlampa Enterprises also helps health care professionals implement holistic wellness programs into their existing practice with the goal to educate both the health care provider and the patient. The programs, which provide the health care professional with a substantial additional income stream in this ever changing medical marketplace, allow the patient to achieve true wellness instead of receiving a traditional treatment for symptoms.

Orlampa Enterprises is an internet based product broker specializing in personalized health and wellness related services. Orlampa Enterprises is primed to continue its growth by duplicating its successful business model of educating, training, and developing entrepreneurial leaders as business partners. As an Unfranchise™ business owner, Orlampa Enterprises, proudly utilizes highly researched products including nutraMetrix® nutritional supplements. 

 Orlampa Enterprises' motto is "Eat well, exercise, and supplement intelligently."

Contact Beth at bb@orlampa.com or 727.492.8212 for more information about nutraMetrix® partnership opportunities available.