Should Children Use a Multi-Vitamin?

TCNMadmin 2017 September 3

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This is an article I wrote for EcoParent Magazine’s Fall 2017 Issue. It hasn’t been posted Online, but I’ve posted it here!

After I submitted it, I was contacted by the editor and asked for a few changes – apparently some of the magazines advertisers were manufacturers of vitamins, and their products don’t meet the standards I suggest in my article. For the print version, we edited out sections of the article, including some relevant quality suggestions (I didn’t object to the edits because EcoParent are friends, and I’m not interested in putting them in a tough spot).

Anyway, below is the article in it’s entirety, including “all the names”.

– Jonah Lusis, ND

Should Children Use a Multi-Vitamin/Mineral?

Too many years ago, while as a student working in a health store in Toronto, I was asked by the storeowner to offer customers samples of a children’s multi-vitamin/mineral.

I did so, unaware at the time that the issue was so controversial! More than one parent indignantly declined, declaring that their pediatrician claimed children did not require nutritional supplementation.

Were their pediatricians right?

Let me preface this discussion by disclosing that I am not a “supplements naturopath” – my modus operandi is to focus on correcting a patient’s lifestyle, but I am not averse to supplementation, particularly if on consideration of available evidence it is indicated.

The intent of multi-vitamin/mineral use is to compensate for nutritional shortcomings in a persons diet.

The obvious first question is: Is a child consuming all the nutrients they require from the food they are eating?

A 2006 report prepared by the Region of Waterloo Public Health and the University of Waterloo determined that 68% of grade six students in the Waterloo Region of Ontario were not meeting the Canada’s Food Guide to Healthy Eating guidelines for fruit and vegetable consumption. The same study found that consumption of “meat and alternatives” (e.g., tofu) was inadequate in 46% of students, an important factor in the associated findings of inadequate intake of iron and zinc, in 11% and 31% of students, respectively¹.

Another study determined that 0% of (adult) subjects were able to meet their micronutrient (i.e., vitamins and minerals) Recommended Daily Allowances (RDA’s) through diet alone².

Canada’s Food Guide to Healthy Eating, which does not offer the most up-to-date nutritional guidelines (in my opinion, better guidelines are available here) recommends children younger than 13 years of age eat:

• 4 to 6 servings of vegetables and fruit daily (low, in my opinion)
• 1 to 2 servings of meat and meat alternatives daily³.

Does your child meet these guidelines? If not, consider supplementing their diet with a multi-vitamin/mineral.

Any multi-?

As with all things in life, quality in nutritional supplements is wide-ranging, and as a rule, you get what you pay for.

There are a wide range of factors that determine the quality any nutritional supplement. For example:

• Does the product contain the full spectrum of nutrients required for health, and in adequate quantities?
• Minerals and vitamins are available in differing forms (e.g., magnesium carbonate may result in net loss of magnesium from the body; compared to magnesium glycinate, which is more efficiently absorbed and better tolerated⁴). Does the product contain well-absorbed, well-tolerated, optimally bioactive forms of nutrients?
• Certain nutrients (e.g., vitamin A, iron), consumed in excess, are potentially toxic. Does the product contain excessive amounts of potentially toxic nutrients?

The Comparative Guide to Nutritional Supplements™ assesses and rates over 1’300 multi-vitamin/minerals quality on the above, and 14 other criteria, offering a score out of five stars. The majority of “cheap”, “store brands” earned very poor ratings (“one star” representing a fairly typical score)⁴.

A review of the ingredients list of Flintstones™ Complete Chewables Multivitamins reveals:

• An absence of minerals except calcium and iron (e.g., magnesium, selenium, zinc).
• Calcium in the relatively lower-quality calcium carbonate form⁴.
• Folate in the form of folic acid, which may increase risk of colon cancer⁵.
• B₁₂ in the relatively inferior cyanocobalamin form (compared to the methylcobalamin), which requires depletion of stores of other important nutrients for absorption⁶.
• Vitamin E in the synthetic, poorly bioactive d/l-alpha tocopherol form (as opposed to d-alpha tocopherol, which is absorbed at two times the rate⁴).

Also important to consider are the non-therapeutic ingredients. The #1 Brand Choice of Canadian Pediatricians also:

• Appears to contain quite a bit of sugar. The exact amount of sugar is not included on the label, but confectioner’s sugar, corn syrup solids (which are 100% sugar) and dextrose monohydrate (sugar) are three of the first seven ingredients listed.
• Contains sorbitol which may cause digestive upset.
• Contains several food colorings, including Red 40 and Yellow 6, both of which contain the carcinogen benzidine⁷.

Many reviewing the ingredient list will note that I did not include aspartame, the most plentiful ingredient listed, as a point of concern. Although controversial, the current scientific evidence suggests that aspartame is safe for human consumption⁸.

What about the risks I’ve heard about?

Over the past decade or so, several studies⁹ have been published that have demonstrated a correlation between multi-vitamin/mineral use and rates of cancer development.

Although receiving much publicity, the relationship is between is these is weak, statistically not such that a causal relationship is the appropriate conclusion (an analogy may be if it was noted that persons taller than 180 cm had very slightly higher cancer rates, it would be incorrect to draw the conclusion that being tall causes cancer).

The Bottom Line

Take the time to learn and understand how be consistently eating a balanced, nutrient-rich diet, including what constitutes food serving sizes.

Keep a food journal to determine of your routine allows you to consistently offer your child a healthy, balanced diet (and as importantly, do they eat it).

If you are concerned that your child is not eating in a way that ensures adequate nutrition, use a multi-vitamin/mineral – there is very little to support that using nutritional supplements to correct nutritional deficiencies (as opposed to using “mega-doses” of nutrients) is harmful (even the authors of studies arriving at conclusions critical of multi-vitamin/mineral use concede their use is indicated to correct nutritional deficiencies¹⁰).

To find a high-quality multi-vitamin/mineral for your child:

• Shop for a “children’s” multi-vitamin/mineral, which will include potentially toxic nutrients in amounts appropriate for children’s smaller bodies
• Visit a health store for a higher-quality range of options than a national drug or grocery store chains
• Be willing to invest in a quality product – even a seemingly expensive product will typically amount to approximately $1.00 daily

References

1. Hanning R, Toews J. Food and physical activity behaviours of grade 6 students in Waterloo Region. Region of Waterloo: Population Health Research Group; 2007. [cited 2017 Apr 29]. Available from: http://chd.region.waterloo.on.ca/en/researchResourcesPublications/resources/Grade6lifestyle_report.pdf.
2. Misner B. Food alone may not provide sufficient micronutrients for preventing deficiency. Journal of the International Society of Sports Nutrition [Internet]. 2006 Jun 5 [cited 2017 Apr 29]. Available from: https://jissn.biomedcentral.com/articles/10.1186/1550-2783-3-1-51.
3. Health Canada [Internet]. Ottawa How much food should you need every day. [cited 2017 Apr 29] Available from: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/quantit-eng.php.
4. MacWilliam L. Comparative guide to nutritional supplements™. 5th professional ed. Northern Dimension Publishing; 2014. pp. 53-72, 90-103.
5. Mason JB, Dickstein A, Jacques PF, Haggarty P, Selhub J, Dallal G et al. A temporal association between folic acid fortification and an increase in colorectal cancer rates may Be illuminating important biological principles: a hypothesis. Cancer Epidemiol Biomarkers Prev July 1 2007 (16) (7) 1325-1329; DOI:10.1158/1055-9965.EPI-07-0329.
6. Obeid R, Fedosov SN, Nexo E. Cobalamin coenzyme forms are not likely to be superior to cyano- and hydroxyl-cobalamin in prevention or treatment of cobalamin deficiency. Molecular Nutrition & Food Research. 2015;59(7):1364-1372. doi:10.1002/mnfr.201500019.
7. Potera C. Diet and nutrition: the artificial food dye blues. Environmental Health Perspectives. 2010;118(10):A428.
8. Arnarson A. Aspartame: good or bad. Authority Nutrition: An Evidence-based Approach [Internet]. [cited 2017 Apr 29]. Available from: https://authoritynutrition.com/aspartame-good-or-bad/.
9. Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR. Dietary supplements and mortality in older women: the Iowa Women’s Health Study. Archives of internal medicine. 2011;171(18):1625-1633. doi:10.1001/archinternmed.2011.445.
10. Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013;159:850-851. doi: 10.7326/0003-4819-159-12-201312170-00011.