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Does My Child Need to Take Probiotics?

by with No Comment Child & Family NutritionDigestive HealthInfant NutritionSupplementationToddler Nutrition

You’ve heard that probiotics are important for good digestion and immune function. Does that mean you should supplement your kids? What strain will help provide the best support for your child’s digestive system and relieve their constipation? I dive into the latest research about probiotics and health and provide tips for choosing the right supplements for your children. 

WHAT ARE PROBIOTICS?

Probiotics are a combination of live beneficial bacteria (and/or yeasts) that naturally live in our body. We have two kinds of bacteria constantly in and on our body — good bacteria and bad bacteria. Probiotics exist naturally in some foods and are also available as dietary supplements in powder, capsule, and tablet forms. The World Health Organization and the Food and Agriculture Organization of the United Nations call probiotics the “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”

So we hear that probiotics are good for us. But a lot of the information that you will find about probiotics is not all that useful and does not help us decide whether the probiotics found in food are good enough, or if we need supplements. And if we need supplements which strain of probiotic should we get? How much of a dosage do we need to see a benefit? How long to take it for? And what type of benefit can I expect?

THE PROBIOTIC STRAINS ARE KEY 

There are many different species of probiotics, and many different strains within species. That means when we say “probiotics”, we are actually referring to many different types, not just one.

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.

In general, you’ll find many supplements will have a variety of Lactobacillus and Bifidobacterium species some limited to just one or two strains, others with several.

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 (CFU), which indicate the number of viable cells. Amounts may be written on product labels as, for example, 1 x 109 for 1 billion CFU or 1 x 1010 for 10 billion CFU. Many probiotic supplements contain 1 to 10 billion CFU per dose, but some products contain up to 50 billion CFU or more. However, higher CFU counts do not necessarily improve the product’s health effects.

Manufactures should have storage conditions listed on the label. Stability testing is conducted under the same temperature as the recommended storage condition on the label.  Because probiotics must be consumed alive to have health benefits and they can die during their shelf life, users should look for products labeled with the number of CFU at the end of the product’s shelf life (the expired date), not at the time of manufacture.

When choosing your child’s probiotic, considering the amount of each strain is important. Most research suggests the minimum quantity of bacteria needed to generate therapeutic effects is 1 x 109 for 1 billion CFU. So you need to think billions when selecting a supplement.

Some of the gummies and chewable probiotics targeted to kids or packaged probiotic foods like bars you’ll find in the supermarket, simply don’t have a high enough dosage to gain any health benefits.

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

An infant’s gut microbiome is very vulnerable and lacks diversity compared to adults. It’s estimated young babies have approximately 10 different species whereas an adult has over 1000 species. A baby’s microbiome born vaginally is predominantly made up of Bifidobacterium species verses an adult’s microbiome which is dominated by Lactobacillus species.

After the age of 2, the child’s gut microbiome composition resembles that of an adult and is much more stable.

As a result, you’ll want a probiotic supplement that contains a higher dosage of beneficial bacteria in children over the age of 2. And, you won’t necessarily need to be limited to just kids specific products and brands.

If you’re breastfeeding, you may also want to assess your own gut health as bacteria will be transferred from the intestines to your baby’s through your breastmilk.

WHEN YOUR CHILD NEED A PROBIOTIC SUPPLEMENT?

 Antibiotic-Associated Diarrhea

Antibiotics can reduce the amount of friendly bacteria in the gut, both good and bad bacteria, which lowers the body’s defenses against other types of invaders, including bacteria, yeasts, fungi, and parasites. Taking probiotics containing Lactobaciallus rhamnosus GG and Saccharomyces boulardii may help to replace the bacteria lost as a result of antibiotic use and reduce the risk of antibiotic-associated diarrhea, which occurs in 40% of children on antibiotics (here, here).

Most probiotics should be taken after taking the antibiotics, so that they won’t be affected by the antibiotic.

Acute gastroenteritis (not related to antibiotic use)

Sometimes your child will just have diarrhea for a variety of reasons (most likely due to a viral or bacterial infection). Research has shown that there can be a reduction of stool frequency and duration of diarrhea experienced (by about 1 day) in children when probiotics containing Lactobacillus rhamnosus GG and Saccharomyces boulardii are taken (here).

Constipation

There is very limited evidence at this point, but some studies do show an increase in stool frequency with the use of probiotics. However, there is not good consensus on the dose or the type of probiotic (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% until the child’s 6th birthday and beyond. 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 kids, 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 strains found in yogurt are L. bulgaricus and S. thermophilus. Yogurts labeled as having “live active cultures” must have at least 100 million live active bacteria per gram.

The key to introducing probiotic foods to your child is to start low and go slow to reduce any unpleasant side effects such as bloating and flatulence. Start with half a teaspoon every second day and slowly build up from there. To increase bacteria diversity and encourage a healthy gut environment, include a selection of different probiotic foods into your child’s diet and don’t forget about prebiotics.

BOTTOM LINE

There’s a lot of anecdotal evidence supporting probiotic use in children. But the health benefits may be strain-specific. A strain that helps one condition may be useless against another. For that reason (and due to lack of research), there’s no clear answer as to whether you should give your child probiotics, especially for long periods of time.

Giving probiotics to children isn’t without risk. Children with compromised immune systems may experience infection. Others may have gas and bloating. Probiotics can cause serious side effects in very sick infants. Check with your pediatrician before giving probiotic supplements to your child.

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.

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Does My Child Need to Take Multivitamins?

by with No Comment Child & Family NutritionSupplementationToddler Nutrition

If you have a toddler who has a meltdown at the thought of eating more than two bites of something green, you know that getting children to eat a well-balanced diet isn’t easy. Whether to start giving your child vitamins is a question many parents have, as well as at what age they should start? Which brand to choose? What should be in multivitamins? However, for most healthy children, vitamins are unnecessary.

According to the American Academy of Pediatrics, children receiving a normal, well-rounded diet do not need vitamin supplements at all. Still, it can be difficult to know how many vitamins your child is getting each week. A toddler’s plate after dinner is finished may look like 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 

When parents aren’t sure their children are getting the proper 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 analyze their child’s diet, they often find their “picky eater” is actually getting more variety than they initially thought. But under certain circumstances, some children don’t eat a normal, well-balanced diet, and may need to supplement with vitamins or minerals, such as those who:

  • are extreme picky eater and struggle to eat a variety diet
  • have food allergy
  • follow a vegetarian or vegan diet
  • have abnormal growth pattern
  • have a medical or digestive condition that affects the absorption of or increases the need for nutrients, such as celiac disease, cystic fibrosis, inflammatory bowel disease (IBD) or cancer

If your picky eater has a poor appetite or has been omitting whole food groups for a long period of time, you will likely need to temporarily support them with a multivitamin as picky eater may experience with low intake of zinc and iron.

Children who follow vegetarian or vegan diets may need to take specific supplement (ex:  vitamin B12 – found in animal foods). Another example, if a child who doesn’t consume seafood, I may recommend supplementation with Omega-3 fatty acids (DHA & EPA). For a child who is allergic dairy or does not consume dairy products, I’d recommend vitamin D and calcium.

If your child is experiencing declining or stagnant growth on their growth curve, it could mean that they’re not absorbing nutrients (medical or digestive problems) or their appetite is low due to a mineral deficiency (ex: iron deficiency anemia).

Children who have inflammatory bowel disease or celiac disease might have difficulty absorbing several minerals and vitamins like vitamin D, calcium, iron and zinc. It is because the diseases cause damage to the areas of the gut which absorb micro-nutrients. Additionally, kids with cystic fibrosis have trouble absorbing fat and may not absorb fat-soluble vitamins – A, D, E, and K. Children who take certain medications that interfere with intake may need a supplement.

Giving a multivitamin with various vitamins and minerals that aren’t actually targeted at what your child needs based on what is lacking in their intake is like shooting in the dark. You’re unlikely to actually see good results! Instead, work with dietitian to analyze your child’s diet, and help you find targeted supplements that might help.

THE RISK OF TAKING TOO MUCH SUPPLEMENT 

MegaDose 

A lot of marketing companies are constantly trying to convince us that children are just generally “picky” and need a multivitamin to fill the nutrition gap. And often these marketing campaigns are targeted at children themselves and their apparent need for a wide range of low dose multivitamins. This type of marketing can be very misleading, especially if you have a fairly healthy child that is eating a generally varied diet as is. As a result, parents may be spending money on something that is just not needed, or risking giving their children too many vitamins, resulting in overdose on certain vitamins, especially Vitamins A, D, E and K. Be very careful when you see a multivitamin that contains 100% of a vitamin/mineral dose per day or more (even when ingredients, etc. look great! See example here).

Not a magic pill 

Some parents also treat multivitamins as an insurance policy, a way to ease a parent’s worry. But, it can also mask the underlying problem of an extremely unhealthy eating habit, no supplement can replace feeding kids a well-balanced diet.

Avoid artificial colours and sugar 

So many popular multivitamins out there are just full of sugar, dyes and fillers. You want your children’s multivitamin to taste good enough that they’ll take it, but you’ll also want to avoid products that are high in sugar and/or include artificial sweeteners like high fructose corn syrup or Aspartame. Also, the sugars in gummy vitamins can contribute to dental cavities.

Never refer to vitamins as ‘candy’

Finally, the fact that many look and taste exactly like candy. Always read the label on the back for how many vitamins your child should be taking (usually one a day) and keep them out of sight of your children, as kids often think of them as candy and try to eat more than one per day.

WHAT AGE SHOULD MY 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 vitamin supplements. However, infants do have different nutrient needs than older children and may require supplements. For example, some breastfed babies need a vitamin D supplement.

It’s important to ask your pediatrician if your child may require any supplementation, and always check with your child’s doctor first before administering any vitamins or supplements.

WHAT SHOULD I LOOK FOR? 

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 in Malaysia.

Every health supplement registered with MOH has two key features. The first key feature is the registration number (known as the MAL registration number) that starts with the letters MAL followed by eight digits ending with the letter N (ex: MAL 12345678 N). 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 is considered a safety feature for all MOH registered health products as it is highly sophisticated and cannot be replicated.

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

Supplements that are third-party tested are sent to a lab where they are tested to ensure they contain what they say they contain and are not contaminated with specific high-risk, common contaminants. However, it’s important to note:

  1. Third party testing does not test to see if a product is effective or safe for everyone, and it does not ensure the supplement will not interact with other supplements or medications.
  2. Not all third-party testing is created equal. It is not uncommon for supplement companies to pay labs for certificates after conducting minimal to no testing.
  3. The third party certifications we can trust are: ConsumerLab, NSF, and USP. However, these certifications are difficult to obtain and/or expensive for manufacturers, so many companies choose not to get their products tested by one of these three organizations.
  4. Sometimes products tested by these three companies are more expensive to try to offset the cost they pay for certification.
  5. Just because a supplement is not tested by one of these three companies, it does not mean it’s a bad product. We recommend doing some research on the reputability of the manufacturer, and calling up the manufacturer and their testing lab to determine their protocols and decide if you feel comfortable consuming the supplement.

Form

Multivitamins come in a variety of forms:

  • Chewables
  • Gummies
  • Liquid
  • Powdered

The one you choose will be up to you depending on what your child accepts more easily and what the vitamin content of each one is.

For example, most kids enjoy chewable gummies, however they usually contain a bit more sugar than other versions. That being said, this may be the only way you can consistently get your child to take the vitamins, and so in that case, it may be worth it to purchase these. However, gummies don’t usually have high levels of iron in them. You also want to be conscious of the fact that gummies are a choking hazard for kids under 4, so if offering them, chop it up into smaller pieces to make it safer for younger children.

Chewable tablet vitamins tend to have higher iron doses,  so pay attention to this if this is a main nutrient of concern for your child. The liquid and powdered supplements can come in many flavours and parents often find that mixing them into a smoothie or yogurt is the best way to get it in. The trick here is, making sure your child takes the smoothie or yogurt + vitamin mixture daily!

Of course, taking into consideration cost of a product, accessibility, as well as all the other factors described above is going to be important and individual to every family. Weight out your pros and cons and remember to consult a doctor or dietitian for specific advice.

BOTTOM LINE

Research tells us that for healthy toddlers, a nutritious diet is the best way to be getting all the vitamins and minerals they need. Whole foods offer more/better absorbed nutrients than multivitamins can offer. So generally speaking, if your child is healthy (growing along their growth curve, no medical/nutritional diagnosis), eats a decent variety of foods, is active and sees a doctor regularly, they should not need a multivitamin.

Finally, if you have a picky eater, or are unsure of how to feed your toddler or what to feed your toddler to raise a healthy, happy eater, you can check out my Peaceful Mealtimes course for help. You will learn how to slowly begin introducing more fresh, whole foods to your toddler so that eventually, they may not need to rely on a multivitamin anymore.

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

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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:

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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.

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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. 

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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.