Forums: September 2010 Kickstart Forum Archive: Follow Up Questions from Pediatrician Call
Created on: 09/15/10 08:57 PM Views: 1965 Replies: 8
samdoug Joined: 09/15/10 Posts: 2	Follow Up Questions from Pediatrician Call Posted Wednesday, September 15, 2010 at 8:57 PM Hello, I really enjoyed the call with Dr. Brown and Dr. Gordon, and have a couple of questions that I didn't have the opportunity to ask... 1. Dr. Gordon mentioned calcium dosage requirements for children is uncertain but said maybe between 4 and 500 mg is adequate, and a supplement will cover that. What wasn't specified is the mg requirement for B12. I don't really want to give my children vitamin supplements, as I'd rather it come from their foods, but if they aren't getting enough B12 through fortified cereals etc, I will pick up a supplement. 2. I read on BabyCenter (I know, probably not the most reliable source!), that children raised on vegan diets may not reach their full height potential. Is that in any way substantiated by evidence?! I don't even know how that would be proven?! Thank you so much for whomever can help answer these questions! Samantha
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Susan Levin Joined: 12/26/09 Posts: 1190	RE: Follow Up Questions from Pediatrician Call Posted Wednesday, September 15, 2010 at 9:09 PM It was really good, wasn't it? In honor of Dr. Gordon, I'll do the second question first: 2. No, there does not seem to be any difference between the heights of lifelong vegan/vegetarians and those raised non-vegetarian. This is specifically referenced in the American Dietetic Association's position paper on vegetarian and vegan diets. If you don't have that paper, you need it. It's a great resource. For context, the ADA is a VERY conservative organization and the world's largest organization of nutrition professionals. The paper also concludes that vegan diets in childhood and adolescence are not only nutritionally sound, but they set lifelong healthful eating habits that offer "important nutritional advantages." 1. Reliable B12 in foods is supplemented. So in a way, you are taking a supplement by eating those foods. However, you have to be sure you are eating those foods everyday. If you don't know, or you don't want to think about it, just take the supplement. There are kids' supplements that are yummy and have B12. Susan Levin, MS, RD PCRM Director of Nutrition Education
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samdoug Joined: 09/15/10 Posts: 2	RE: Follow Up Questions from Pediatrician Call Posted Wednesday, September 15, 2010 at 9:16 PM Yes, the call was great! I would love to hear that another is planned... I really wish they were based in Tampa, Florida!! I had no luck finding a pediatrician on the search engine So, for the B12, my kids eat Cheerios each morning, but the box says it only has 25% of the daily recommended amount per cup. My 6 year old probably has 2 cups and my 2 year old just one. So, I know that's not enough. Maybe 3-4 times per week, they have nutritional yeast sprinkled on their pasta or veggies, but again not a daily consistent thing. I don't want to get hung up on it, but it is confusing. I'm really not a pill popper type, but if I'm putting my kids at risk, there's no way I won't find a way for them to take a supplement. Are you able to suggest the dosage I should look for? I'm imagining there will be a ton of options at the health food store. Also, I'm concerned about possible over-supplementation with vitamins which has steered me clear so far. Am I overestimating that risk? Thank you! Wow, so great that you're here as a resource!
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Susan Levin Joined: 12/26/09 Posts: 1190	RE: Follow Up Questions from Pediatrician Call Posted Wednesday, September 15, 2010 at 9:37 PM There doesn't seem to be any risk with mega-dosing B12. But I totally agree with you, why would you want to? For kids 9-13, the RDA is 1.8 mcg. For kids 14-18, it's the same as adults, 2.4 mcg. It's not much. If I were you, I would find a B12 vitamin, or just go ahead and get a kids multi with 100% of the RDA. Our modern food supply is crazy in order to deal with our not-so-natural lifestyles. Even our grains are supplemented with folate to deal with our low folate intake (fyi - vegans have a high folate intake). There's vitamin D in different foods to compensate for our lack of outdoor time in the sun. By choosing a vegan diet you are making great strides toward not needing compensation. So don't feel bad about needing one supplement, B12. Also, just do it! Susan Levin, MS, RD PCRM Director of Nutrition Education
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Bugsmom Joined: 09/13/10 Posts: 2069	RE: Follow Up Questions from Pediatrician Call Posted Thursday, September 16, 2010 at 9:04 AM Susan Levin wrote: For kids 9-13, the RDA is 1.8 mcg. For kids 14-18, it's the same as adults, 2.4 mcg. It's not much. If I were you, I would find a B12 vitamin, or just go ahead and get a kids multi with 100% of the RDA. There's vitamin D in different foods to compensate for our lack of outdoor time in the sun. By choosing a vegan diet you are making great strides toward not needing compensation. So don't feel bad about needing one supplement, B12. Also, just do it! Thank you! I've been trying to track down how much B12 is needed for us (me, hubby, 12 yr old son) so this is timely. Yesterday we were heading out to a friend's house and son stood in the sunshine and said "ahhhh, vitamin D!" LOL Being in northern climes, making sure we have supplemental D (from foods etc) is something I've been keeping an eye on. --Deb
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Bugsmom Joined: 09/13/10 Posts: 2069	RE: Follow Up Questions from Pediatrician Call Posted Thursday, September 16, 2010 at 12:55 PM I looked up Cheerios on a website I go to for finding the label info on all sorts of stuff. It indicated that Cheerios (1 cup serving) has 1.5 mcg of B12. That is nearly a full 100% for kids in the under 13 group (9-13?) and a good more than half for an adult. I'm also seeing people talking about taking 2000 mg (mcg? I don't remember which it was tagged with) per week. If it divided evenly over the week, that'd be something like 5 times the RDA. I'm sure there's a "half life" or something where it dissipates over time at a different rate (not an even amount every day). So, now I'm a bit confused with the whole thing. What's the deal with fortified cereals, supplements, daily or weekly, and the required amounts? --Deb
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DrDons Joined: 01/11/10 Location: Sacramento, CA Posts: 17	RE: Follow Up Questions from Pediatrician Call Posted Thursday, September 16, 2010 at 1:42 PM Just to add to the excellent information that Susan Levin provided on B12 and to add my answer to Samantha's question on height. For Adults: I have found the most useful recommendations for B12 are those of Michael Greger MD (Director of Public Health and Animal Agriculture for the American Humane Society). These are for 2010: Vitamin B12: • At least 2000 mcg (?g) once each week, ideally as a chewable, sublingual, or liquid supplement. • Or at least 100 mcg daily of supplemental B12 (you needn’t worry about taking too much) • Or at least 2 servings daily (with a minimum of 6 hours between servings) of B-12 fortified foods, each containing at least 30% “Daily Value” as listed on its label, such as a cup of fortified soy milk. • Tip: if experiencing symptoms the best test is urine MMA level (not serum B12) Personally I have found a 2500 mcg sub lingual tablet once a week is the most convenient. For younger children you can adjust down per Susan's recommendations and discuss with your child's physician. I often recommend that patients get cholesterol, glucose and hgbA1c tests about 1 month after going plant based so they can see their progress. A serum B12 test can be added to the list. This serves more as a baseline since when we go plant based we usually have alot of B12 stored from our previous animal consumption habits. A brief comment on the height question. If anything I would predict(haven't seen the study yet) that children raised vegan would be taller than if they were raised on Standard American Diet. We know that early onset of puberty leads to earlier growth spurt which also closes off the growth plates. Most data is pointing toward consumption of meat and dairy and increased body per cent body fat in children as the best explanations for the earlier onset of puberty in children. It would follow then that children raised on plant based diet with adequate B12 and sunlight exposure (Vit D) would end up taller. I hope this helps. Be well. Don Forrester MD Don www
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Bugsmom Joined: 09/13/10 Posts: 2069	RE: Follow Up Questions from Pediatrician Call Posted Thursday, September 16, 2010 at 1:47 PM Pardon me for being a bit dense here but how does the 100 mcg per day supplement square with Susan's information on the RDA of 2.4 mcg per day? I can understand that there's not a problem of having extra (I'm guessing it works similar to vitamin C - whatever you don't need get passed along) but why would one choose to supplement if two cups of Cheerios (for example) would accomplish the RDA without having to purchase an additional item? There must be a piece I'm missing here - perhaps the fortified food sources aren't as well absorbed? --Deb
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jmyers1050 Joined: 12/31/09 Location: Arizona Posts: 43	RE: Follow Up Questions from Pediatrician Call Posted Friday, September 17, 2010 at 12:36 AM The various amounts may not seem to make sense, but my understanding is that the less often you take B-12, the higher the amount needed as only a fraction is absorbed. So if you take it twice a day in supplemented foods, a bigger percentage is absorbed than if you take it once a day or once a week so daily or weekly doses have to be higher. Lots of folks don't want to depend on fortified foods because they may not eat those same foods every day. It's easier for me to take a 1000 mcg supplement twice a week but you are right - if you eat supplemented foods every day, you really don't need the pills.
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