Healthy Kids MakeHealthy Adults

Optimizing Nutrition andDisease Prevention in Pediatrics

Jackie Busse, MD, FAAP

International Plant Based Nutrition Healthcare Conference

September 24, 2019

Outline

• Importance and Impact of Childhood Nutrition• Adult diseases

• Pediatric diseases

• Teaching taste

• Nutritional Needs in Childhood

• What About Cow’s Milk?

• What Should Kids Drink?

• Common Questions• Growth

• Soy

• Calcium and Iron

• Supplements

Official Endorsement

• American Academy of Pediatrics (AAP)

• “Children can be well nourished on all three types of vegetarian diets (lacto-ovo, lacto, vegan)...”

• Academy of Nutrition and Dietetics (AND)

• “appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and…appropriate for all stages of the life cycle, including pregnancy, lactation, INFANCY, CHILDHOOD, adolescence, older adulthood, and for athletes”

Plant Based Diets for Kids

• Higher intake of:

• Fiber

• All vitamins and minerals (except Calcium)

• Fruits and veggies

• Variety of whole foods

• Adequate:

• Calories

• Protein

• Lower intake of:

• Total fat, sat fat, cholesterol

Messina V, et al. (J Am Diet Assoc) 2001

Importance and Impact of Childhood Nutrition

Impact of Childhood Nutrition on Adult-Onset Disease

Epigenetics

•Genotype = DNA

•Phenotype = expression• Effected by environment

• Environmental factors → tag the DNA with markers → switch genes on or off → alters expression

• Infants get a ‘clean slate’ via reprogramming

https://www.whatisepigenetics.com

Epigenetics

• 1% of genes escape reprogramming→ Parents lifestyle choices

can be passed down→ Epigenetic inheritance

• Pregnancy• 3 generations at once

https://www.whatisepigenetics.com

Diet and Epigenetics

•Early nutritional environment that a fetus and infant develops affects late onset disease risk

•Cardiovascular disease, obesity, metabolic disease

•The SAD adversely alters our epigenetics

Mukerjee et al. (Cell Molecular Neurobiology) 2018. Barua S et al, (Epigenomics) 2015

Heart Disease Starts in Childhood

•Earliest signs of heart disease seen as young as 3 years old

W. Enos, et al. (JAMA) 1953. W. Enos, et al. (Am J of Card), 1962. Strong, J, et al. (J of Atherosclerosis), 1969. Strong J, (JAMA) 1986

10Years

20Years

30Years

40Years

50Years

60Years

FattyStreaks

VisiblePlaques

FibrousPlaque

SymptomaticHeart Disease

Childhood Nutrition and Cancer Risk

• Factors Associated with Increased Overall Cancer Risk:• Less fruit consumption

• Less total plant fiber

• More meat consumption (earlier is worse)

• Higher processed meat consumption

• Overweight in childhood

• Higher calorie intake

• Rapid growth at an early age

• Taller stature in childhood

• Earlier pubertyMaynard, et al. (J Epid Comm Health) 2003. Frankel, et al. (BMJ) 1998. Erickson KL, et al. (Am J Clin Nutr) 2001. Satia-About a J, et al. (Int J Cancer) 2004. Caygill D, et al. (Euro J Can Prev) 1998. Engeland A, et al. (J Natl Cancer Inst) 2003. Barker DJ, et al. (Lancet) 1995. Fairfield KM, et al. (Obstet Gynecol) 2002. Tsuji K, et al. (Biomed Environ) 1996. Frankel S, et al. (BMJ) 1998. OkashaM, et al. (Best Pract Res Clin Endocrinol Metab) 2002. Must A, et al. (Nutr Rec) 1999. Wang DY, et al. (Breat Cancer Res Treat) 1997. Albanes D, et al. (Cancer Res) 1988. Baaners AN, et al. (Eur J Cancer Preb) 1993. Swerdlow AJ, et al. (J Natl Cancer Inst) 2002. Hamilton AS, et al. 2003. Berkey CS, et al. (Am J Epidemiol) 2000. Brunk D, et al. (Family Practice News) 2003. Anderson SO, et al. (Cancer Epid Biomarkers & Prev) 1995

RED MEATall mammalian muscle meat:

beef, veal, pork, lamb, mutton, horse, and goat

PROCESSED MEATmeat that has been salted, cured, fermented, smoked or otherwise

processed:hot dogs, ham, sausages, corned

beef, beef jerky, canned meat, some deli meats

Obesity and Diabetes in Kids

Sabaté J et al, (Am J Clin Nutr) 2010. Orlich MJ, et al. (JAMA Intern Med) 2013. Must A, et al. (NEJM) 1992. Macknin M et al. (Pediatrics) 2015

Pre

vale

nce

(%

) o

f O

verw

eigh

t an

d O

bes

e

Years

Prevalence trends for child overweight and obesity in the USA

> 30%

• Obese kids tend to

become obese adults

• A child’s obesity health

risks remain, even if

they lose the weight in

adulthood

• Type 2 Diabetes follows• As young as 8y/o

• Cuts almost 20 years

off life expectancy

Impact of Childhood Nutrition on Pediatric Diseases

Pediatric Asthma

• #1 Chronic Disease of Childhood

• 10% of kids – 6% of office visits– $6 billion/year

• Worldwide disease burden varies greatly

• <1% in areas of China to 27% in Australia

• Environmental factors – diet!

Asher MI et al. (Respir Res)2010. Seyedrezazadeh E et at. (Nutr Rev) 2014. Asthma Related Physician Visits, From: www.cdc.gov November 2018

The more plants kids eat,

the less asthma they get!

Benefits of Plant Based Diet

• PROTECTIVE effect from:

• Healthy body weight

• Fewer omega 6 fatty acids

• Lower dietary sodium

• Lower saturated fat

• Higher antioxidant intake

• Avoidance of dairy

• Healthy gut microbiome

• Fewer toxins, pollutants and heavy metals

Egan K et al. (Pediatrics) 2013. Wendell SG et al. ( J Allergy Clin Imm) 2014 . G Wood et al. (J Am Coll Nutr) 2005. B Björkstén. (Semin Immunopath) 2004

Similar Patterns for…

• Allergic Rhinitis (Hayfever)

• Atopic Dermatitis (Eczema)

• Frequency of colds and flu

• Upper Respiratory Infections

• Acne

• Migraines

• ADHD?

Barnard, Neal. PCRM: Nutrition Guide for Clinicians, 2018

Constipation

• 30% of kids – 5% of office visits – $4 billion/year

• Nearly 100% preventable

• Fiber deficiency

• RDA’s: 19 – 38g

• Average intake: 13g

• Inadequate fruits and vegetables

• 60% of kids don’t eat enough fruit

• 93% of kids don’t eat enough veggies

• Dairy

Afzal, NA et al. (Can J Gastro) 2011. Borowitz SM et al. (Pediatrics) 2005. Van den Berg M, et al. (Am J Gastro) 2006. Irastorza I, et al. (J Ped Gastro Nutr) 2010. CDC, NHANES 2014

Teaching Taste andHealthy Habits

Teaching Taste

• The only taste preference we are born

with is mother’s milk

• ALL other tastes are learned, starting at

15wks gestation

• Babies prefer foods that Mom ate during

pregnancy and breastfeeding

• Early flavor experiences build the

foundation for lifelong taste preferences

• Tastes are set by 2 – 6 yrs old!

Menella J, et al. , (Pediatrics) 1991. Unusan N. (Food Quality and Preference) 2006. Mennella J, et al. (Pediatrics) 2001

Huge Opportunity!

• We teach children to prefer high fat, high sugar foods

• WE CAN TEACH THE OPPOSITE!

• Children exposed to healthy, plant-based foods get used to them and prefer them

Nutritional Needsin Childhood

Nutritional Needs of Kids vs Adults

•Above the age of 3 yrs• Minimal difference

•From 0 – 3 yrs: • Higher fat

• Higher protein

• Higher calorie density

• Higher nutrient density

The physician’s committee. Vegetarian diets for children: right from the start. 2002

Nutritional Needs of Kids vs Adults

• Per kilogram, kids need:

• 50% more protein

• Twice as much fat

• 3 – 4x more calories

• As percent of calories, kids need:

• Protein 10 – 14%

• Fat 30 – 40%

• Well within what you can get from plant foods

Plant Based 1 ½ Year Old

Breakfast SnackLunch Dinner

Nutrient Recommendations

Whole Food Plant Based Diet

Calories 1,000 kcal 656kcal

Fat 30-40% of kcal 26%

Protein 10-20% of kcal 15%

Carbohydrates 45-65% of kcal 57%

Fiber 19g 19g

Plant Based 1 ½ Year Old

Messina V, et al. (J Am Diet Assoc) 2001. IOM,: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005)

Nutrient Recommendations

Calories 1,000 kcal

Fat 30-40% of kcal

Protein 10-20% of kcal

Carbohydrates 45-65% of kcal

Fiber 19g

Plant Based 1 ½ Year OldNutrient

RecommendationsWhole Food Plant

Based Diet+ 15oz of

Breastmilk

Calories 1,000 kcal 656kcal 1,000

Fat 30-40% of kcal 26% 36%

Protein 10-20% of kcal 15% 12%

Carbohydrates 45-65% of kcal 57% 52%

Fiber 19g 19g 19g

Nutrient Recommendations

Whole Food Plant Based Diet

Calories 1,000 kcal 656kcal

Fat 30-40% of kcal 26%

Protein 10-20% of kcal 15%

Carbohydrates 45-65% of kcal 57%

Fiber 19g 19g

Role of Breast Milk

Breastmilk Composition

Lactose Protein Oligosacharrides Fats

Oligosacharrides

8%

Protein

6%

Lactose

54%

Fats

32%

• High carb

• High fat

• Low protein

Lactose Intolerance

Lomer et al, (Alimentary Ohar and Ther) 2008. Heyman et al. (Pediatrics) 2006

weaning

What About Cow’s Milk?

AAP Milk Recommendations

• Calories for growth, fat for brain/eye development

0 – 1 yr No cow’s milk

1 – 2 yr 2 – 3 cups of whole milk

2 – 3 yr Up to 2 cups of 1% or skim milk

4 – 5 yr Up to 2.5 cups of 1% of skim milk

History of Milk Recs?

• Medical recommendations were largely reactionary

• 1900’s: Breastfeeding plummeted

• 1950’s: AAP Committee on Nutrition

• 1960’s: Medical concerns growing

• Trend since 1950’s has been to delay the introduction of cow’s milk

• Cultural certainty VS medical UNcertainty

Cowgill, B. Making the Case for Milk: It’s Cloudy. 2016 From: www.anotherschoolofthought.com. Apple, R. Mothers and Medicine: A Social History of Infant Feeding, 1890-1950,. 1987. Apple, R. (J Hum Lact) 1994. Bentley, A. Booming Baby Food: Infant Food and Feeding in Post-World War II America. Michigan Historical Review, 2006Ward, J, et al. Silent Victories: The History and Practice of Public Health in 20th Century America. 2006. Curry, L. ( J of Am His) 2003. Samuel J., (J of Nutrition) 2001. Samuel J. (Am J Clin Nutr) 1987. Kleinman, et al. 2016

Compared to Human Milk

• Protein:

• Almost 5x more protein/kcal

• Opposite casein:whey ratio

• 7x more casein

Michaëlsson, K, et al. (BMJ) 2014

• Carbohydrates:

• Low carbohydrate

• Lack of oligosaccharides

Compared to Human Milk

• Fats

• High saturated fat

• Low unsaturated fat

Compared to Human Milk

Compared to Human Milk

• Mineral imbalance:

Ziegler E, (Nestle Nutr Workshop) 2007. Alexander KC, et al. (Ped & Child Health) 2003

Component HUMAN Per 100g

COWPer 100g

Calcium 34mg 120mg

Iron 0.07mg 0.02mg

Na, K, Cl, Phos, Mg Appropriate 2 – 5x higher

Reframing the Milk Discussion

NOT A FOODA highly specialized and complex maternal-neonatal relay

system developed through mammalian evolution to promote species-specific postnatal growth and assure species-specific

postnatal metabolic programming

Melnik, B, et al. (Nutr J)2013. Michaëlsson, K et al. (BMJ) 2014. Grosvenor et al, (Endocrine Reviews,)1992. German JB, et al. (Current Opinion in Clin Nutr and Met Care) 2002

Growth hormone (GH)Insulin-like growth factor-1 (IGF-1)

Insulin

Transfer of bovine amino acids

(BCAA’s)(Leucine)

mTORC1 ACTIVATION

INCREASED

mTOR Activation

• Nutrient sensitive kinase

• Controls cell growth

• Accelerated aging, cell proliferation, insulin production

• Onset of age-related diseases

• Cow’s milk induces a significantlyhigher magnitude of mTOR activation than human milk

Melnik, B et al. (BMJJ) 2014. Melnik, B, et al. (J Obes)2012

Growth Rate of Cows vs Humans

0

200

400

600

800

1000

1200

1400

1600

Birth 2 Years 4 Years 6 Years 8 Years 10 Years 12 Years 14 Years 16 Years 18 Years 20 Years

Growth Rate to Maturation of Cow vs Human

Human Cow

COW2 yrs

HUMAN20 yrs

Age (years)

Wei

ght

(po

un

ds)

Daily Milk Intake During Pregnancy (mL)In

crea

se in

Bir

thw

eigh

t (g

)

Milk-Driven Growth Patterns

•Kids who drink cow’s milk grow bigger and faster

Garnas, E. Is it Healthy to Drink Milk? 10 Questions with Bodo Melnik (MD); Professor of Dermatology, University of Osnabrück, Germany. 2018 From: http://darwinian-medicine.com. Berkey et al, (Archives of Ped and Adol Med) 2005

HUMAN

Historic Milk Exposure

Pregnancy Infancy Childhood Adolescence Adulthood

Garnas, E. Is it Healthy to Drink Milk? 10 Questions with Bodo Melnik (MD); Professor of Dermatology, University of Osnabrück, Germany. 2018 From: http://darwinian-medicine.com. Berkey et al, (Archives of Ped and Adol Med) 2005. Melnik, B. (J Obes) 2012

Lifelong Milk Exposure

COWCOW

Pregnancy Infancy Childhood AdulthoodAdolescence

Modern Milk Exposure

HUMAN/COW

What Should Kids Drink?

Milk From 0 – 1 Year

1) Mother’s milk2) Banked human milk3) Human milk sharing?4) Organic, non-GMO,

soy formula

Messina M et al. (Nutrition Reviews) 2017. McCloskey RJ et al. ( J Hum Lact) 2018

Milk From 1 – 2 Years

1) Mother’s Milk2) Water or plant based milk

Choosing a Plant Based MilkSimple, clean ingredients

• No added sweeteners

• No added oils

< 2 y/o and/or drinking > 6 oz/day

• Nutrient-dense

• Match breastmilk

> 2 y/o or drinking < 6 oz/day

• Your choice

UNSWEETENEDORGANICNON-GMOSOY MILK

Is Soy Safe for Kids?

Concerns Regarding Phytoestrogens• Soy contains high levels of isoflavones• Phytoestrogens are selective estrogen

receptor modulators • Mimic positive effects without negative

consequences

• Beneficial effects are seen even moresofor childhood intake

• Servings/day:• To reap benefits 1• Blue Zones 2 – 3• Safe 5 – 7

• Benefits do not apply to processed soy!Brzezinski, D. (Eur J Ob & Gyn and Rep Bio) July. Messina, V. RD Resources for Consumers: Safety of Soy Foods. 2017 From: www.vegetariannutrition.net

What About Soy Formula?

• Nutritionally equivalent

• The AAP agrees – soy formulas are safe and appropriate for full term babies

• Best alternative to breastmilk that we have

• Nearly 100 years of use

• Adults who were given soy formula as infants:

• No biologically significant findings in terms of general or reproductive health or cancer development

Messina M, et al. (Nutrition Reviews) 2017. Canadian Paediatric Society. (Paediatr Child Health) 2009. Strom et al. (JAMA) 2001. Stevens, et al. (J Perinat Educ) 2009

AnsweringCommonQuestions

Does a Plant Based Diet Affect Children’s Growth?

Early Studies were Concerning

•Multiple early studies on ‘vegan’ kids:

• Growth retardation

• Malnutrition

• Nutrient deficiencies

Jacobs et al (Am J Clin Nutr) 1988. Dagnelie, P et al. (Am J Clin Nutr) 1994. Dagnelie, P (Acta Paediatr Scand Suppl) 1991. Shinwell, E (Pediatrics) 1982. Zmora, E et al. (Am J Dis Child) 1979

Morency, M, et al. (Am J Clin Nut) 2017. Lannotti et al. (Pediatrics) 2017

Real Story

• Inappropriate diets regardless of source of food

• Inadequate calories, protein and/or fat

• ‘Vegan’ as umbrella for a wide range of unusual, restrictive diets

• Homemade ‘formula’ or milks in the first year

• Study flaws

• Assumption that bigger is better and smaller is bad

• Focus on single foods and not nutrients or whole diet

• Short follow up

Jacobs et al (Am J Clin Nutr) 1988. Dagnelie, P et al. (Am J Clin Nutr) 1994. Dagnelie, P (Acta Paediatr Scand Suppl) 1991. Shinwell, E (Pediatrics) 1982. Zmora, E et al. (Am J Dis Child) 1979

Growth Patterns

•Plant based kids experience:• Slower growth in early childhood

• Later onset of puberty/menarche

• Later, slower, growth spurt • Longer growth period

• Equal or greater adult height

•Smaller size & slower growth• Improved health

• Increased longevity Weder S, et al. (VeChi Diet Study). (Nutrients) 2019. O'Connell J, et al. The Farm Study. (Pediatrics) 1989. Orlich MJ, et al. Adventist Health Study 2. (JAMA Intern Med) 2013. Sanders et al. (J Hum Nutr Diet) 1992. Fulton et al. (J Am Diet Assoc) 1980. Sanders et al. (J Hum Nutr) 1981. Sanders et al (Am J Clin Nutr) 1988. Sanders et al. (Pediatr Clin N Am) 1995.

Nutrition and Timing of Puberty

Villamor E, et al. (Annu Rev Public Health) 2016. Wiley, A et al. NHANES 1999-2004. 2011. Boaz, N, Essentials of biological anthropology. 1999Raymond, R et al. Recombinant Bovine Somatotropin (rbST): A Safety Assessment. ADSA-CSAS-ASAS Joint Annual Meeting. Montreal, Canada. July 14, 2009

Year

Ave

rage

Age

of

Men

arch

e

Nutrition and Timing of Puberty

Earlier Puberty Later PubertyObesity Lower weight

Rapid weight gain Slower growth

Meat < 7 yrs High vegetable protein

Animal protein < 7 yrs High fiber intake

High saturated fat Soy intake (girls)

High dairy

Low vegetable protein

Villamor E, et al. (Annu Rev Public Health) 2016. Wiley, A et al. NHANES 1999-2004. 2011. Boaz, N, Essentials of biological anthropology. 1999Raymond, R et al. Recombinant Bovine Somatotropin (rbST): A Safety Assessment. ADSA-CSAS-ASAS Joint Annual Meeting. Montreal, Canada. July 14, 2009

Earlier PubertyObesity

Rapid weight gain

Meat < 7 yrs

Animal protein < 7 yrs

High saturated fat

High dairy

Low vegetable protein

What About Calcium andBone Health?

Optimizing Bone Health

•Peak bone mass achieved by 18 – 20 y/o

• Key determinant of our lifetime risk of osteoporosis and fracture

•Genetic factors: 60-80%

•Modifiable factors: Calcium intake

• Concern:

• Calcium intakes of plant based kids are below the RDA’s

Messina V, et al. (J Am Diet Assoc) 2001. Backrach, L et al. (Trends Endocrinol Metab) 2001

The Calcium Paradox

Abelow, B et al. (Calcific Tissue Int) 1992. Frassetto, L, et al. (J Gerontol A Biol Sci Med Sci) 2000. Joint FAO/WHO Report. Vitamin and mineral requirements in human nutrition. 1998

Calcium Review Studies in Pediatrics

•3 large metanalyses • Ca intake, dairy intake, Ca supplementation

•Conclusions:• Dietary calcium and dairy products do not have a

clinically relevant impact on bone health, especially long term

• Public health would be better served by researching the other modifiable factors that affect children's bone health

Wosje, K et al. ( Nutr Rev )2000. Lanou, A, et al. (Pediatrics) 2005. Winzenberg, T, et al. (BMJ) 2006

Optimizing Bone Health in Kids

• Adequate calcium intake

• Likely lower than current RDAs

• Weight bearing exercise, especially in childhood

• Adequate Vitamin D

• Low sodium diet

• Avoiding excess dietary protein, especially animal protein

• Lots of fruits and veggies

Alexy et al, (Am J Clin Nutr) 2005. Lloyd et al (J of Pediatrics) 2004. Franssetto, et al, (J of Gerontology) 2008. Bischoff-Ferrari et al, (J of Bone and Mineral Res) 2009. Lanou,, A, (BMJ) 2006

What I Recommend

• Get outside every day

• Play! 2 – 3 hours every day

• Plant based diet

• Calcium rich foods every day

• Beans, greens, soy, nuts/seeds

Do Plant Based KidsGet Enough Iron?

Iron • Iron deficiency is the most common nutrient deficiency in childhood

•Vegans and vegetarians do NOT have higher rates

•Plant based kids

• Meet or exceed RDA’s, often more than omnivorous kids

• Higher intake of Vit C → 4 – 6X increased absorption

• Avoidance of dairy

Saunders, A et al. (Med J Aust) 2013. Gupta, P et al. (Nutrients) 2016. Gibson, R et al. (Am J Clin Nutr) 2014. Baker, R et al. (Pediatrics) 2010.

Iron

•Dairy intake is one of the of the biggest factors for iron deficiency:

• It is very low in iron

• Replaces calories from healthier foods

• Interferes with iron absorption from other foods

• Can cause microhemorrhage in the gut

•Daily intake of iron rich foods• Beans, greens, fortified grains

Do Plant Based Kids NeedAny Supplements?

Vitamin B12

Age in YearsRDA

(mcg)

Practical Dosing(mcg)

Daily / Weekly

0 – 9mo 0.5Breastmilk or

Formula

9mo – 3 1 50 / 500

4 – 13 1.2 50 / 500

14 + 2.5 100 / 1,000

Vitamin D

• Meant to get from Sunshine:

• 10 – 20 min of direct midday sun

• 50% of skin exposed

• 3 – 4x/week

• Recommended Supplement Dosing:

• 0 – 1 yr: 400 IU per day

• 1 – 5 yrs: 600 IU per day

• > 5 yrs without adequate sun: 600 IU per day

Omega 3s

• ALA (plant foods) → EPA → DHA

• Benefit to supplementing:

• Women who are pregnant or breastfeeding

• Young kids, starting around 1yr

• No harm to supplementing for kids

• WHO Recommendations for DHA/EPA:

• 1 – 4 yrs: 100 – 150mg

• 4 – 6 yrs: 150 – 200mg

• 6 – 10 yrs: 200 – 250mg

• 10 + yrs: 250mg

Messina V, et al. (J Am Diet Assoc) 2001. Saunders, A et al. (Med J Aust) 2013

Iodine?

• Plant based kids are at higher risk for deficiency

• Avoidance of fish and dairy

• Some plant foods (cruciferous veggies and others) can interfere with uptake of iodine in the thyroid

• Supplement?

• Depends on overall diet, geography, soil health, etc

• Infants: breastmilk or formula

• Around 1 yr: supplement or iodized salt

Mangels, R. Iodine and Young Children 2018. From: www.veganhealth.org. NIH, Office of Dietary Supplements: Iodine, Fact Sheet for Health Professionals. 2019

Supplement Summary

Yes• B12

• Vitamin D

Probably• Omega 3’s

Maybe• Iodine

Multivitamin?

PatientStories

Recommendations

0 – 6 mo:

6 – 12 mo:

12 – 24 mo:

2 – 3 yr:

4 – 5 yr:

Lott M, et al. Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations. Consensus Statement. 2019. http://healthyeatingresearch.org.

2 – 3c of whole milk

1– 4c of water

< 4oz of 100% juice

Breast milk or formula

Introduce water

Breast milk or formula 2c of low milk milk

1 – 4c of water

< 4oz of 100% juice

2.5c low fat milk

1.5 – 5c water

< 4 – 6oz of 100% juice

Restrictions on Sweetened Beverages

• Flavored milks

• “Transitional” or toddler formulas

• Drinks with caffeine

• Low-calorie sweetened drinks

• Sugar-sweetened drinks

• Soda, fruit drinks, sports drinks, energy drinks, sweetened waters

• Plant based milks

• “only when medically indicated”

Lott M, et al. Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations. Consensus Statement. 2019. http://healthyeatingresearch.org.

De-emphasized Breast Milk

•Not mentioned after 12 months

•Against WHO

•Adds to existing confusion

Cow’s Milk as Gold Standard

• “…did not conduct a literature search on the heath impact of (milk) as existing recommendations for young children’s milk consumption are highly consistent.”

• “Milk is the number one source of energy, calcium, vitamin A, vitamin D, and zinc for infants and young children, making it a critical component of a healthy diet”

Denounced Plant Milks

• “Not nutritionally equivalent to dairy milk”

• Inadequate Vitamin D

• Added sugars

• Poor bioavailability of minerals: Ca, Zn, Mg, Fe

• More expensive

1) Not Nutritionally Equivalent

• Cow’s milk should not be the gold standard

• Significantly different than human milk

• Not designed for humans

2) Inadequate Vitamin D

• Vitamin D is artificially added to cow’s milk

3) Added Sugars

• Use unsweetened varieties

4) Poor Absorption of Minerals

• Iron and Zinc

• No milks are great sources or Fe or Zn

• No studies specifically looking at absorption from soy milk – speculative?

• NIH: while compounds such as phytates can bind minerals and decrease absorption…

• These interactions probably have little or no nutritional consequence

• Plant based eaters do not show deficiency

• Calcium

• When calcium carbonate is used, Ca absorption from soymilk is equivalent to cows' milk

Zhao Y, et al. (J Nutr) 2005. TangA, et al. (Asia Pac J Clin Nutr) 2010. NIH ODS Factsheet: Calcium

5) More Expensive

• Milk consumption has declined steadily since the 1970s

• Production continues to climb

• Government support of dairy industry

• 73% of U.S. dairy producers’ revenue comes from government programs

• Surplus of milk and cheese

Truth about Plant Based Milks

• Not in the first year

• After 1 year, totally fine!

• Can absolutely be part of a healthy diet for kids

• Unsweetened

• From 1 – 3 y/o, choose a nutrient dense option = soy

Take Aways• Human breast milk is the ideal beverage for infants and toddlers

• Cow’s milk is not formulated for humans

• Detrimental to human health, particularly in childhood

• Childhood nutrition has a huge impact on lifelong health

• A WFPB diet is the best choice for children

• Kids can readily meet their nutritional needs with plants