does-my-child-need-to-take-probiotic-photo

Does My Child Need to Take Probiotics?

by with No Comment Child & Family NutritionDigestive HealthInfant NutritionSupplementationToddler Nutrition

You’ve probably heard that probiotics are important for good digestion and immune function. But does that mean you should supplement your child’s diet with them? Which probiotic strains offer the best support for your child’s digestive system or help relieve constipation?

 

WHAT ARE PROBIOTICS?

Probiotics are a combination of live beneficial bacteria (and/or yeasts) that naturally live in our bodies. We all carry a mix of good and bad bacteria. Probiotics exist naturally in certain foods and are also available as dietary supplements in powder, capsule, and tablet forms. According to the World Health Organization and the Food and Agriculture Organization of the United Nations, probiotics are “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”

So we know that probiotics are good for us. Should we rely on probiotic-rich foods alone? Do we need supplements? If so, which strain? At what dose? For how long? And for what specific benefit?

 

THE PROBIOTIC STRAINS ARE KEY 

When we say “probiotics,” we’re not talking about a single type. There are many different species,  and within each species, multiple strains. The strain level is crucial because different strains serve different purposes.

GENUS: A genus is a biological classification of living organisms. The term comes from the Latin genus meaning group. A genus contains one or more species. Examples of common probiotic genera include Bifidobacterium and Lactobacillus.

SPECIES: ‘Species’ refers to a type of microorganism existing within a genus or family. For example, acidophilus is the name of a species within the Lactobacillus genus.

STRAIN: A probiotic ‘strain’ is a genetic variant or subtype of a species. Different probiotic supplements contain different strains, which may be classified under the same species and genus. However, one acidophilus is not equal to another acidophilus. It’s the strain level that matters when you choose a probiotic in order to help with a specific health condition. If you neglect to pay attention to the specific strains in the kids probiotic, you may not be able to gain the health benefits you desire, and as such, be wasting your money.

Different supplements contain different strains. Two products may both include Lactobacillus acidophilus, but only specific strains are proven to benefit particular health conditions. If you don’t pay attention to the strain, you might not get the benefits you’re expecting and end up wasting money.

Bifidobacterium longum BB536;

Bifidobacterium breve M-16V;

Bifidobacterium infantis M63;

Lactobacillus acidophilus LAC 361;

Galacto-oligo saccharides (GOS)

THE NUMBERS OF THE PROBIOTIC STRAINS MATTER

Probiotics are measured in colony forming units (CFUs), which indicate the number of viable (live and active) bacteria cells. Product labels may express amounts as, for example, 1 x 109 for 1 billion CFU or 1 x 1010 for 10 billion CFU. Most probiotic supplements contain 1 to 10 billion CFU per dose, but some products contain up to 50 billion CFU or more. However, a higher CFU count doesn’t necessarily lead to better health effects.

Manufactures should list storage conditions on the label. Stability testing is typically conducted under the same temperature conditions as the recommended for storage.  Because probiotics must be consumed alive to provide health benefits and some bacteria can die over time, look for products that specify the number of CFUs at the end of the product’s shelf life (the expiry date), not just at the time of manufacture.

When choosing a probiotic for your child, the amount of each strain matters. Most research suggests that a minimum of 1 billion CFU (1 x 109) per strain is needed to produce a therapeutic effect. So you need to think in billions when selecting a supplement.

Some children’s gummies and probiotics snack bars may not contain enough CFUs to be therapeutically effective.

For infants, the dosage should be 5-10 billion CFU per day. For children over the age of 2, the desired dosage should be 10-25 billion CFU per day.

CONSIDERING YOUR CHILD’S AGE IS IMPORTANT

Infants have less diverse gut microbiome compared to older children and adults. It’s estimated that young babies have approximately 10 different bacterial species, whereas adults may have over 1000 species. In babies born vaginally, microbiome is predominantly made up of Bifidobacterium species, whereas in adults, it is more commonly  dominated by Lactobacillus species.

After the age of 2, a child’s gut microbiome starts to resemble that of an adult and becomes significantly more stable.

As a result, for children over the age of 2, you’ll want a probiotic supplement with a higher dosage of beneficial bacteria. At this stage, you don’t necessarily need to stick to kids-specific products and brands, many adult formulations may be appropriate.

If you’re breastfeeding, it’s also worth assessing your own gut health, as beneficial bacteria can be transferred from your intestines to your baby through breastmilk.

 

WHEN MIGHT YOUR CHILD NEED A PROBIOTIC SUPPLEMENT?

 Probiotics can be helpful in certain situations. Here’s what research shows:

Antibiotic-Associated Diarrhea

Up to 40% of children on antibiotics experience diarrhea (here, here). Antibiotics wipe out both good and bad bacteria in the gut. Probiotic strains like Lactobacillus rhamnosus GG and Saccharomyces boulardii can help restore balance and reduce the risk of diarrhea. Take the probiotic a few hours after the antibiotic dose to avoid inactivation.

Acute gastroenteritis (not related to antibiotic use)

If your child gets a stomach bug, these same strains—L. rhamnosus GG and S. boulardii—may shorten the duration of diarrhea by about one day (here).

Constipation

The evidence is still limited. Some studies show slight improvements in stool frequency, but there is no strong consensus on which strain or dose is most effective (here).

Atopic Dermatitis / Eczema

Several studies and reviews have looked at the role of probiotics in preventing and treating atopic dermatitis. While some of the research has provided mixed reviews, many studies have found that infant at risk for developing eczema have benefited from taking probiotics with the  Lactobacillus rhamnosus GG strain (here). Other beneficial strains include Bifidobacterium lactis UABLA-12 and Lactobacillus acidophilus DDS-1 (here)

And, the protective effect of probiotics may be strongest when given to pregnant mothers.  Three studies using Lactobacillus rhamnosus GG given to pregnant women for 2-4 weeks before labour and continued treatment post-birth found significantly lower rates of eczema/atopic dermatitis during the first 2 years of life (here, here, here) so we probably want to make sure that moms are getting a good supply of these beneficial bacteria before baby is even born.

A New Zealand study was the first randomised controlled trial to show that Lactobacillus rhamnosus HN001 can be beneficial for childhood eczema. The key is to start supplementation with rhamnosus HN001 early from 35 weeks of pregnancy until two years of age (here).

The health benefits of rhamnosus HN001 include reduced risk of childhood eczema by 44% up to age 6. The protection continued even after supplementation was stopped by the child’s 2nd birthday. This confirms that not all probiotics are the same. Rhamnosus HN001 is also thought to reduce symptoms of postpartum depression in women.

Functional Gastrointestinal Disorders

A recent systematic review focused on probiotics and functional gastrointestinal disorders in children birth – 18 years yielded no studies on infants and young children (birth – 2 years old). While their search included studies on probiotics that reported on gastrointestinal outcomes such as abdominal pain, stool frequency, stool consistency and bloating/flatulence, these studies did not include infants and young children. Therefore, as evidence is not available for infants and young children, no probiotics can be recommended to improve functional gastrointestinal disorders for those 2 years and under at this time (here).

Infantile Colic

Colic is difficult to understand, and even more difficult to treat.  As a parent who has lived through colic, I know and understand the desperation in trying to find a solution. Research shows that a specific bacterial strain called Lactobacillus reuteri 17938 has been associated with decreased crying spells in exclusively breastfed infants during the first three months of life (here, here, here, here. here, here).

Immune Health 

As parents, we’re always looking for ways to reduce the number of colds and flus that find their way into our lives! Maintaining a healthy population of gut bacteria, along with a healthy diet and lifestyle may be key to staying healthy during cold and flu season. A recent meta-analysis of probiotic use (specifically Lactobacillus and Bifidobacterium strains) in children and adults revealed significantly fewer numbers of days of illness per person, shorter illness episodes by almost a day, and fewer numbers of days absent from day care/school/work (here).

 

WHAT TO LOOK FOR IN PROBIOTIC SUPPLEMENTS 

If you’ve decided to buy a probiotic supplement for your children, prepare yourself for a dizzying array of options. The particular brand you purchase doesn’t matter as much as a few key criteria, which I’ve outlined for you below:

  • “Live, active cultures.” Make sure the supplement you choose contains this actual phrase right on the bottle, so you can be sure you’re getting an effective product. Some brands of probiotic supplements even come refrigerated to help protect these living cells.
  • High bacteria count. The concentration of bacteria in probiotic supplements is measured in CFUs (that’s “colony forming units.”) Look for a probiotic supplement that has, at a minimum, 1 billion CFUs (on the “expiration” or “use by” date on the product label).
  • Multiple strains. Balance matters! Different strains of probiotics can have different health effects. A supplement with eight or ten different strains of bacteria may help to diversify the bacteria that make up your kids’ microbiome.
  • Enteric coating. This refers to a hard coating on the outside of the pill that lets it survive the journey through the harsh, acidic stomach. An enteric coating means that bacteria are released in the intestines, where they can thrive.

FOODS CONTAINING PROBIOTICS

Many parents forget to consider probiotic strains that can be included in the child’s diet to enhance gut bacteria diversity. If you’re choosing a probiotic supplement to provide general support for your child’s immune health or digestive function, please focusing on foods first.

Common foods containing probiotics include yogurt, Kefir, kimchi, sourdough bread, sauerkraut, kombucha, miso, tempeh, fermented vegetables.

YOGURT VS PROBIOTIC 

The most common probiotic strains found in yogurt are L. bulgaricus and S. thermophilus. Yogurts labeled with “live active cultures” must contain at least 100 million live active bacteria per gram to meet the standard.

When introducing probiotic foods to your child, the key is to start low and go slow. This helps minimize potential side effects such as bloating and gas. Start with just half a teaspoon every second day and slowly build up from there. To support a healthy gut and encourage microbial diversity, aim to include a variety of probiotic-rich foods in your child’s diet and don’t forget about prebiotics, the fibers that feed those beneficial bacteria.

BOTTOM LINE

There is a growing body of anecdotal evidence supporting the use of probiotics in children. However, the health benefits of probiotics are strain-specific, a strain that may help with one condition could be ineffective for another. Because of this, and the limited amount of high quality research, there is no clear recommendation on whether children should take probiotics routinely, especially for long periods of time.

It’s also important to understand that probiotics are not without risks. Children with compromised immune systems may be at risk for infection, and others may experience side effects such as gas and bloating. In very ill infants, probiotics could potentially lead to serious complications. Always consult your child’s pediatrician before starting any probiotic supplement.

Did you know that I offer personalized one-on-one nutrition counselling for children and families? If this is something you’s like to learn more about, check out my service.

does-my-child-need-to-take-multivitamins-photo

Does My Child Need to Take Multivitamins?

by with No Comment Child & Family NutritionSupplementationToddler Nutrition

If your toddler has a meltdown at the thought of eating more than two bites of something green, you’re not alone. Getting children to eat a well-balanced diet isn’t always easy. This leads many parents to wonder: Should I start giving my child vitamins? At what age? Which brand? What should I look for in a multivitamin?

The good news is, for most healthy children, vitamins are usually unnecessary.

According to the American Academy of Pediatrics, children who eat a normal, well-rounded diet typically do not need vitamin supplements. But we all know that reality can look very different. After dinner, your toddler’s plate may resemble a crime scene. Did they actually consume any of that broccoli, or did it just get pushed around?

 

REASONS TO GIVE YOUR CHILD A MULTIVITAMIN 

It’s common for parents to worry about whether their child is getting enough nutrients to achieve good health, their first route will immediately jump to a multivitamin. In my Peaceful Mealtimes online course, I teach parents how to evaluate their child’s diet, and many are surprised to find their “picky eater” is actually getting more variety than they initially thought. However, some children may benefits from supplementation under certain circumstances, especially if they:

  • are extremely picky and struggle to eat a variety diet
  • have food allergies or intolerances
  • follow a vegetarian or vegan diet
  • show abnormal growth patterns
  • have medical or digestive conditions that impair nutrient absorption, such as celiac disease, cystic fibrosis, inflammatory bowel disease (IBD) or cancer

If your picky eater has a poor appetite or has been omitting entire food groups for a prolonged period, you will likely need to temporarily support them with a multivitamin. Picky eaters are often at risk of low intake of nutrients such as zinc and iron.

Children who follow vegetarian or vegan diets may require specific supplement (e.g.,  vitamin B12, which is found only in animal foods). Similarly, for children who don’t consume seafood, I often recommend supplementation with Omega-3 fatty acids (DHA and EPA). If a child is allergic to dairy or does not consume dairy products, I would typically recommend vitamin D and calcium supplements.

If your child is experiencing declining or stagnant growth on their growth curve, it may indicate that they are not properly absorbing nutrients, possibly  due to medical or digestive problems, or that their appetite is low due to a nutrient deficiency (e.g., iron deficiency anemia).

Children with inflammatory bowel disease or celiac disease may have difficulty absorbing several vitamins and minerals, including vitamin D, calcium, iron and zinc. These conditions can damage parts of the gut responsible for nutrient absorption. Additionally, children with cystic fibrosis may struggle to absorb fat and, as a result, may not absorb fat-soluble vitamins (A, D, E, and K). Children taking certain medications that interfere with nutrient absorption may also need supplement.

Giving a multivitamin that includes a wide range of vitamins and minerals without targeting your child’s specific needs is like shooting in the dark. You’re unlikely to see good results! Instead, work with a dietitian to analyze your child’s diet and identify any specific nutrient gaps. Targeted supplementation based on individual needs is far more effective.

 

THE RISK OF TAKING TOO MUCH SUPPLEMENT 

MegaDose 

Supplement marketing often targets parents and even children, pushing the idea that multivitamins are a must for every picky eater. This type of marketing can be very misleading, especially if your child is generally healthy and eats a reasonably varied diet as is. As a result, parents may end up spending money on something unnecessary, or risking giving their child too many vitamins. Overconsumption of certain vitamins, particularly the fat-soluble ones (A, D, E and K), can lead to toxicity over time. Be very careful with multivitamins that provide 100% or more of the recommended daily intake of any nutrient, even if the ingredients list appears ok.

Not a magic pill 

Some parents use multivitamins as an “insurance policy”, to feel better about their child eating. But, supplements can mask underlying nutrition concerns, such as consistently poor dietary variety. No multivitamin can replace the long-term benefits of a balanced, whole-food-based diet.

Avoid artificial colours and sugar 

Many popular multivitamins are full of sugar, dyes and fillers. Look for options without artificial sweeteners like high fructose corn syrup or Aspartame. Also, note that sugary gummies can contribute to dental cavities.

Never refer to vitamins as ‘candy’

Many children’s vitamins look and taste like candy. Always keep them out of reach and never refer to them as candy. Accidental overconsumption can be dangerous. Stick to the dosage instructions, usually one per day.

 

WHAT AGE SHOULD A CHILD START TAKING VITAMINS? 

I know we all want to do the best for our children but if your child eats a healthy, well-balanced diet, they don’t need multivitamins. However, infants have different nutrient needs than older children and may require supplements. For example, breastfed babies should receive a Vitamin D supplement, as breastmilk alone may not provide adequate amounts.

It’s important to speak with your pediatrician or dietitian before starting any supplement.

WHAT TO LOOK FOR? 

In Malaysia, the National Pharmaceutical Regulatory Agency (NPRA) under the Ministry of Health Malaysia (MOH) is the only agency to regulate the registration, licensing, surveillance and quality control as well as Good Manufacturing Practice of supplements.

Every health supplement registered with MOH has two key features. The first key feature is the MAL Registration Number that starts with “MAL”, followed by 8 digits, and ends with the and “N” (e.g., MAL 12345678N). The letter “N” at the end of the MAL registration number indicates the type of product, which in this case stands for “supplements”.

The second key feature of registered health supplements is the presence of a MOH Hologram sticker on the packaging. This hologram sticker ensures authenticity and product safety.

When selecting a child’s multivitamin, you’ll be looking two options: with and without iron. The choice is yours based on your child’s diet and the perspective of their pediatrician. Most vitamins are water-soluble, which means that your child will simply eliminate whatever they don’t need in their urine. But vitamins A, D, E, and K are stored in the body’s fat. This means that there is a risk of toxicity (levels higher than the recommended). So, when buying a multivitamin, be sure to look at the label. You want to avoid multivitamins that contain more than 100% of the daily value of vitamin (especially of the fat-soluble ones).

Try your best to avoid any artificial colours and dyes that come in a multivitamin or supplement. Be aware that again, there are a lot of multivitamins that are very much like candy and full of sugar.

Third-Party Testing

Not all supplements are created equal. Supplements that undergo third-party testing are sent to independent lab to verify that they contain what they claim and are free from common high-risk contaminants. However, it’s important to understand the limitations of third-party testing:

  1. Third-party testing does not determine whether a product is effective or safe for everyone, nor does it guarantee that the supplement won’t interact with other supplements or medications.
  2. Not all third-party testing is created equal. Some supplement companies may pay for certification with minimal or no actual testing.
  3. The most trusted third-party certifications include ConsumerLab, NSF International, and USP (United States Pharmacopeia). These certifications are difficult and costly to obtain, which is why many companies choose not to pursue them.
  4. Products tested by these organization often more expensive, as companies may raise prices to offset the certification costs.
  5. Just because a supplement doesn’t have one of these certifications doesn’t necessarily mean it’s a poor-quality product. It’s still wise to research the manufacturer’s reputation. If in doubt, contact the company or the lab they use to inquire about their testing procedures, so you can make an informed decision.

Form

Multivitamins come in a variety of forms:

  • Chewable tables 
  • Gummies
  • Liquid
  • Powdered

The best option depends on what your child accepts most easily, as well as the nutrient content of each form.

For example, many children enjoy chewable gummies, however gummies typically contain more sugar than other versions. That said, if gummies are the only form your child will consistently take, it may still be a worthwhile option. Just keep in mind that gummy vitamins usually don’t contain much (or any) iron, and they can pose a choking risk for children under 4 years old. If you choose gummies for a younger child, cut them into smaller pieces to make them safer.

Chewable tablets tend to have higher levels of iron, making them a better choice if iron is a key nutrient concern for your child.

Liquid and powdered supplements are available in a variety of flavours, and many parents find that mixing them into a smoothie or yogurt is an easy and effective way to serve them. The key is consistency, making sure your child takes the mixture daily!

Of course, you’ll also want to consider factors like cost, availability and convenience. Each family’s situation is different, so weigh the pros and cons and consult a doctor or dietitian for personalised advice.

 

BOTTOM LINE

For most healthy toddlers, a balanced diet is the best source of nutrients. Whole foods offer more bioavailable and better-absorbed nutrients than supplements. If your child is growing well, eats a decent variety of food, and has no diagnosed health or nutritional issues, they likely do not need a multivitamin. However, if you’re concerned about your child’s eating habits or nutrient intake, I recommend speaking with your doctor or a dietitian.

If you have a picky eater or feel overwhelmed trying to feed your toddler well,  check out my Peaceful Mealtimes course online course. You will learn practical ways to introduce more fresh, whole foods into your child’s diet, so you may not have to rely on a multivitamin for long.

For more tips and tricks when it comes to feeding your family, head over to Peaceful Mealtimes online course to learn more. 

ive-thalassemia-can-i-take-iron-supplement-photo

I’ve Thalassemia, Can I Take Iron Supplement

by with No Comment Supplementation

Thalassemia is an inherited (i.e., passed from parents to children through genes) blood disorder that causes your body to make less hemoglobin or abnormal hemoglobin.

Hemoglobin is the oxygen-carrying component of the red blood cells. It consists of two different proteins, an alpha and a beta. If the body doesn’t produce enough of either of these two proteins, the red blood cells do not form properly and cannot carry sufficient oxygen. When there are not enough healthy red blood cells, there is also not enough oxygen delivered to all the other cells of the body, which may cause a person to feel tired, weak or short of breath. This is a condition called anemia.

People with thalassemia may have mild or severe anemia. Severe anemia can damage organs and lead to death.

DIAGNOSIS

Your doctor will do an examination and ask about your health history. Tests you may need include:

  • A complete blood count (CBC): to measure hemoglobin and the quantity (size) of red blood cells.
  • An iron level test: to identify whether the cause of the anemia is iron deficiency or thalassemia.
  • A blood test (Hemoglobin Electrophoresis): to measures the amounts of different types of hemoglobin, to help find out which type of thalassemia you have.
  • A gene test: to help confirm mutations in alpha and beta globin-producing genes.

TYPES OF THALASSEMIA

When we talk about different “types” of thalassemia, we might be talking about two things:

  1. the specific part of hemoglobin that is affected – alpha or beta
  2. the severity of thalassemia – trait, carrier, intermedia, or major

Alpha Thalassemia

People whose hemoglobin does not produce enough alpha protein have alpha thalassemia. There are four types of alpha thalassemia that range from mild to severe in their effect on the body.

  • Alpha Thalassemia Silent Carrier
  • Alpha Thalassemia Trait or Mild Alpha Thalassemia
  • Hemoglobin H Disease
  • Alpha Thalassemia Major

Beta Thalassemia

People whose hemoglobin does not produce enough beta protein have beta thalassemia. There are three types of beta thalassemia that also range from mild to severe in their effect on the body.

  • Beta Thalassemia Trait
  • Beta Thalassemia Intermedia
  • Beta Thalassemia Major or Cooley’s Anemia

TREATMENT

Treatments for thalassemias depend on the type and severity of the disorder.

People who are carriers or who have alpha or beta thalassemia trait have mild or no symptoms. They’ll likely need little or no treatment.

1. Blood Transfusions 

  • Hemoglobin H disease or beta thalassemia intermedia, may need blood transfusions on occasion.
  • Beta thalassemia major (Cooley’s anemia), they’ll likely need regular blood transfusions (often every 2 to 4 weeks). These transfusions will help you maintain normal hemoglobin and red blood cell levels.

2. Iron Chelation Therapy 

The hemoglobin in red blood cells is an iron-rich protein. Thus, regular blood transfusions can lead to a buildup of iron in the blood. This condition is called iron overload. It damages the liver, heart, and other parts of the body.

3. Folic Acid Supplements

Folic acid (1-2 mg) is a B vitamin that helps build healthy red blood cells.

4. Blood or Bone Marrow Stem Cell Transplant

A blood and bone marrow stem cell transplant replaces faulty stem cells with healthy ones from another person (a donor). Stem cells are the cells inside bone marrow that make red blood cells and other types of blood cells.

A stem cell transplant is the only treatment that can cure thalassemia. But only a small number of people who have severe thalassemias are able to find a good donor match and have the risky procedure.

BOTTOM LINE

  • Thalassemia is an inherited condition affecting hemoglobin production. The most common outcome is anemia but complications include spleen enlargement and bone problems.
  • Treatment depends on the severity of the thalassemia but may involve regular blood transfusions.
  • People with thalassemia may be advised to avoid iron supplements and foods rich in iron because they are at risk of iron overload.

Did you know that I offer personalized one-on-one nutrition counselling for children and families? If this is something you’s like to learn more about, check out my service.

REFERENCES:

choosing-a-calcium-supplement-photo

Choosing a Calcium Supplement

by with No Comment Supplementation
If your intake of calcium rich foods are low, or your doctor or dietitian has suggested a calcium supplement, it can be overwhelming to know just which one to select. The following information may help you decide.

WHY IS CALCIUM IMPORTANT? 

Calcium is the most abundant mineral in the body. It is key for building and maintaining strong bones and teeth as well as supporting nerve function and muscle contraction. Calcium is also a mineral that is involved in blood pressure and blood clotting. Getting enough calcium is important for preventing osteoporosis, high blood pressure, colon cancer and may even help with premenstrual syndrome.
It’s best to get your calcium from foods; milk, cheese, and dark green leafy vegetables as they are good sources of calcium.

HOW MUCH CALCIUM DO I NEED EACH DAY? 

It depends on how much you’re already getting in your diet.
The Recommended Dietary Allowance (RDA) is the total amount of calcium suggested from foods and supplements each day.
The Tolerable Upper Intake Level (UL)  is the amount you should not exceed per day between food and supplements to prevent adverse effects.

TOO MUCH OF CALCIUM? 

More than the recommended daily amount isn’t good for you. It may even be harmful. Your body gets rid of extra calcium through your kidneys, and it goes into your urine, raising the risk of kidney stones (Nephrolithiasis) for some people. High levels of the mineral in your blood (Hypercalcemia) can lead to kidney problems (Hypercalciuria), as well as hardened blood vessels and tissue. Some studies also link high calcium intake, particularly from supplements, with a greater risk of heart disease, though the results aren’t settled (here, here, here, here, here, here). High calcium intake can cause constipation. It might also interfere with the absorption of iron and zinc, though this effect is not well established.

STEPS TO CHOOSE A CALCIUM SUPPLEMENT 

The best supplement is the one that meets your needs based on tolerance, convenience, cost and availability. Calcium supplements are available with and without a prescription in a wide range of preparations (i.e. tablets, chews, and liquids) and in various strengths.
  • To choose a good calcium supplement, first look for brand names you recognize.
  • IF YOU ARE IN CANADA: Be sure to check the bottle for a Natural Product Number (NPN). This means that the product has been assessed by Health Canada and is considered safe, effective and high quality. Avoid buying supplements over the Internet or outside of Canada. There is no guarantee that they have met the safety standards set by Health Canada. which indicates that the product meets quality control standards.
  • IF YOU ARE IN MALAYSIA: check out this post about what you should look for when choosing supplements.
  • The calcium in supplements is found in combination with another substance, typically carbonate or citrate.
  • Bypass those made from calcium phosphate, calcium lactate or calcium gluconate, because these contain only small amounts of “elemental calcium” (the actual amount of calcium in each supplement), less common and tend to be more expensive
  • Calcium carbonate tends to be the best value, because it has the highest amount of elemental calcium. The compound calcium carbonate contains 40% calcium by weight, while calcium citrate is 21% calcium. This means that you may need to take more tablets of a calcium citrate product in order to meet your daily needs.
  • Calcium carbonate requires extra stomach acid for absorption, it’s best to take with food. Most people tolerate calcium carbonate well. However, some people might experience gastrointestinal side effects including gas, bloating, constipation, or a combination of these symptoms.
  • Calcium citrate is absorbed more easily than calcium carbonate and can be taken on an empty stomach.
  • Calcium citrate is preferred in patients receiving proton pump inhibitors,  are taking acid-blocking medication, or have decreased stomach acid (bariatric patients) since these medications reduce the acid in the stomach, thus making calcium carbonate harder to absorb.
  • Another advantage of calcium citrate is that it may cause less gas, bloating and constipation than calcium carbonate.
  • Steer clear of products containing oyster shell, bone meal or dolomite, because these ingredients can potentially be contaminated with lead or other toxic metals.
  • If you are not keen on swallowing pills you can also consider a liquid or chewable calcium supplement.
  • Regardless of which calcium supplement you choose, be sure to look at the label carefully to assess the dose in each calcium pill. Look on the side of the package or container to find out how much elemental calcium is in each supplement.
  • The more calcium you take at one time, the harder it is for your body to process it. Aim for 500 milligrams or less each time. You may want to take a smaller amount at each meal throughout the day to add up to your total.
  • Try to stay close to the recommended daily allowance of calcium for your age, and do not exceed the upper-level limit.

WHAT FACTORS INFLUENCE CALCIUM ABSORPTION? 

  • Vitamin D
Take calcium supplements along side a vitamin D supplement since it increases calcium absorption significantly.
  • Dose
The percentage of calcium absorbed depends on the total amount of elemental calcium consumed at one time; as the amount increases, the percentage absorption decreases. Take a maximum of 500mg of calcium at a time to maximize absorption.
  • Iron
Avoid taking calcium supplements at the same time as iron supplements since they compete for absorption.
  • Sodium
Be mindful of your sodium intake since high sodium diets increase calcium losses in the urine.
  • Caffeine
Coffee and tea have a moderate impact on calcium loss in the urine although 1 cup of coffee results in a loss of only 2-3 mg of calcium so the loss is considered insignificant.
  • Phytic acid & oxalic acid

Phytic acid naturally found in foods such as whole grains, beans and nuts as well as oxalic acid found in foods such as spinach, sweet potatoes, rhubarb and beans can reduce calcium absorption. If you are consuming a varied diet there is little reason to worry about the interactions.

  • Medications
Some medications can decrease calcium absorption so it is best to speak to your doctor and pharmacist for further advice.
Did you know that I provide personalized nutrition consultation service? If this is something you’d like to learn more about, please visit here.
how-to-choose-a-prenatal-multivitamin-photo

How to Choose a Prenatal Multivitamin?

by with No Comment Fertility & Women's HealthMotherhoodSupplementation

Thinking about getting pregnant? Since many pregnancies are not planned, all women who could become pregnant should take a daily prenatal multivitamin.

It is recommended to start taking your supplement at least 3 months before you get pregnant.

Your nutrient requirements are much higher during pregnancy, it is important that you start taking a prenatal multivitamin before you become pregnant to fill any nutritional gaps. You may say “I eat very healthy and balanced”, however, it’s impossible to meet all of your requirements with food alone. This doesn’t mean that you have to spend a lot of money on buying branded supplements from the health food store .

In fact, I often recommend generic brands from local pharmacies or supermarkets as long as the supplement is government regulated and it contains what it says it contains. So I will give you some tips and what to look for when buying a prenatal multivitamin.

FOLIC ACID 

Folic acid is super important to help prevent Neural Tube Defects (e.g., spinal bifida – when nerves in the spinal cord are exposed and damaged) in your baby. Choose a prenatal multivitamin that has 0.4-1.0 mg (400-1000 mcg) of folic acid.

Food High in Folic Acid: whole grain breads, leafy green vegetables, legumes (beans and lentils), citrus fruits and juices and most cereals (fortified with folic acid).

IRON

Your iron requirements increase during pregnancy. Your body makes an extra 2kg of blood during pregnancy. In your third trimester of pregnancy, your baby is building iron stores for the first six months of his or her life. Therefore, you need more iron to make the extra blood and to help your baby store enough iron.

When you’re pregnant, it is very difficult to get the amount of iron you need just from diet alone, so choose foods high in iron and take a prenatal multivitamin containing iron (16-20 mg). Your body absorbs iron from meat, poultry, and fish better than iron in other foods. To increase iron absorption, eat a food containing Vitamin C (e.g., strawberries or oranges) and food containing iron at the same time. For example, have vegetables with meat (e.g., chicken stir-fry) or have an orange with a bowl of oatmeal. Coffee and tea can interfere with iron absorption. Limit these drinks and have them between meals rather than at meals.

Best Sources of Iron: beef, pork, chicken, lamb, fish, sardines, shrimp, oysters, mussels.

Good Sources of Iron: legumes (lentils, beans, chickpeas), tofu, whole grain and enriched cereals.

Anemia during pregnancy has been linked to decreased weight gain, preterm birth and babies with a low birth weight. If you become anemic during pregnancy (which is very common), your doctor or dietitian may recommend an additional iron supplement. Iron supplements can make you constipated, so be sure to increase your intake of fibre and fluids.

CALCIUM

Your calcium needs are very high during pregnancy. Calcium helps keep your bones strong. It also helps your muscles and nerves to work properly and helps your blood to clot. During pregnancy, calcium helps your baby build strong bones and teeth.

Most prenatal multivitamins contain about 300 mg of calcium. A prenatal multivitamin will not support all of your calcium needs, so it is important that you’re including calcium rich foods in your diet.

Food High in Calcium: milk, yogurt, calcium-fortified beverages such as soy, rice or orange juice.

Other Food Sources of Calcium: cheese, canned salmon or sardines with bones, tofu made with calcium.

VITAMIN D

Vitamin D is important in pregnancy. It helps keep your bones strong and builds strong bones in your baby (enhance calcium absorption). It also helps your baby build vitamin D stores to use during his or her first few months.

If you have a dark skin, cover most of your skin with clothing or sunscreen, don’t go outside very often or don’t eat very many vitamin D rich foods (see below) you may need to take extra vitamin D supplement.

Food High in Vitamin D: milk, fortified soy beverages, fish such as salmon, trout, herring, Atlantic mackerel, sardines, and Vitamin D fortified orange juice.

Not all milk products are high in vitamin D. In Canada, milk, margarine and some yogurts have vitamin D added to them. In Malaysia, please check you nutrition fact label.

VITAMIN A

Too much Vitamin A can cause birth defects in your baby. If you are taking a prenatal multivitamin (which has vitamin A included), do not take any additional vitamin A supplements. You will get enough Vitamin A from a combination of your food (e.g., carrots, broccoli and squash) and your prenatal multivitamin.

BOTTOM LINE

Healthy eating and taking a prenatal multivitamin helps you prepare a healthy pregnancy. Do not take more than 1 daily dose of a prenatal multivitamin. Supplement do not take the place of food and healthy eating. If you are vegan, on a restricted diet, food allergies or you avoid certain foods, you may be missing important nutrients you and your baby need. Talk to you doctor or dietitian.

So, You’re having a baby? Contact Me, I can help you meet the nutrition needs of both you and your growing baby. 

prebiotics-and-probiotics-supplements-photo

Health Benefits of Prebiotics and Probiotics

by with No Comment Digestive HealthSupplementation

Recently, I have seen lots of mommy asking about probiotic supplements? Many health benefits about probiotics have been advertised, but it is often hard to know what is true? Does your child need probiotic supplements? Before you learn about probiotics, have you heard about prebiotics? What are their health benefits? Read on to learn the difference between prebiotics and probiotics and their health benefits.

WHAT IS THE DIFFERENCE BETWEEN PREBIOTICS AND PROBIOTICS? 

Prebiotics are non-digestible carbohydrates that act as “food” for probiotics. Eating prebiotics will help probiotics grow and remain in our digestive system.

Probiotics are healthy/good bacteria that naturally live in the colon of our digestive systems. Probiotics help to keep a balance between the good and bad bacteria that live in your colon. Certain probiotics have been linked to specific health benefits.

TYPE OF PREBIOTICS 

The most common prebiotics include:

  • Fructo-oligosaccharides (FOS) or fructans
  • Galacto-oligosaccharides (GOS)
  • Inulin (a types of FOS)

PREBIOTICS IN NATURAL FOODS 

Inulin

Due to the pleasant taste characteristics and low-calorie status, FOS and inulin have been added to many food products. Inulin has a creamy, catlike texture that makes it a good fat substitute. You will find it in many spreads, salad dressings, dairy products.

FOS, GOS and inulin are found naturally in these foods:

Vegetables

  • Artichoke
  • Asparagus
  • Bananas
  • Garlic
  • Leeks
  • Onion
  • Tomatoes

Grains

  • Barley
  • Rye
  • Whole Grains

Roots

  • Chicory Root (菊苣根)
  • Dandelion Root (蒲公英根)
  • Elecampane Root (土木香根)

Galacto-Oligosaccharides (GOS)

  • Fermented dairy products like yogurt, buttermilk and kefir
  • Breast milk (Hooray!!!) – breastfed babies suffer fewer infections than formula-fed babies

HEALTH BENEFITS OF PREBIOTICS 

Prebiotics act as “food” for probiotics which help to keep a healthy balance of bacteria in the digestive system. Eating prebiotic-containing foods often contain fibre and other nutrients. It also enhances calcium absorption. More research is still needed to find out if prebiotics are linked to other specific health benefits. However, if you do not consume foods that are naturally rich in prebiotics, you can still have a healthy gut by following a healthy and balanced diet

WHERE CAN YOU FIND PROBIOTICS 

Probiotics are healthy bacteria that are either in supplements form or added into certain foods like yogurt, cheese, milk, juice, and cereal. The most common probiotic bacteria added to foods are Lactobacillus and Bifidobacterium species. It is better to read the ingredient list and make sure the product contains the right bacteria. To understand the strains of probiotics, read here.

NAME TO LOOK FOR 

Look at the Nutrition Facts or ingredient lists or products packaging for the names:

HEALTH BENEFITS OF PROBIOTICS 

There are many potential health benefits of adding probiotics to your children’s diet.

It is not yet clear how much probiotics will give you health benefits. However, it is recommended that regular, long-term use is needed to keep healthy bacteria in your digestive system. Please noted that the positive effects of probiotics vary from person to person and strain(s). Individuals who do not consume foods with probiotics can still have a healthy digestive system by eating a healthy diet.

SAFETY CONCERNS 

There are many brands and strains of probiotics that can be found at the pharmacy these day which can leave parents confused. Like many other supplements, over-the-counter prebiotics & probiotics are poorly regulated. That means that there are no rules for how much prebiotics/probiotics there should be in a food or how to label them on food packaging. If you decide to take a supplement, please check to make sure it has NPN, DIN or a DIN-HM number (somewhere on the bottle). Remember, being regulated does not guarantee that probiotics are effective. It only means that the product contains what is stated on the label and that they are safe to take.

It is recommended to choose the probiotic supplement is meant specifically for children – chewable or in a drink form, and it should be refrigerated. Remember to read the instructions regarding how much to give your children and pay attention to the expiry date.

BOTTOM LINE 

Probiotics for your baby or child are a must if they have been on antibiotics. If you have a colicky baby or have troubles with constipation or eczema, I would try probiotic supplement. I would also recommend probiotic supplement for formula-fed babies or those born by C-section (who aren’t exposed to natural vaginal bacteria).

Did you know that I offer personalized one-on-one nutrition counselling for children and families? If this is something you’s like to learn more about, check out my service.