Little Sis calls and asks what should we give to my future linebacker and Olympic swimmer nephews. Loaded question as anyone I care for knows, handing out a one size fits all diet/supplement regime is basic but probably not sustainable.Reminiscing to early practice.... I still remember in my old clinic at CDH, I used to have a folder of exercises put together for specific body aches. Thought I was smart by having things pre-printed for my staff to hand out after I came up with a diagnosis. One day I was walking out after clinic and saw the handouts sitting in the trash at patient checkout. They didn't even wait to get home and dumped the one-size-fits-all hand out in our garbage. Not everyone can afford physical therapy co-pays but if the suffering is bad enough/long enough or surgery is coming-I rather have a personally designed rehab program applied, modified and re-applied to get the body to heal itself properly.
Reminiscing to youth, my Sis and I grew up in a kitchen where mom had a meat dinner every night and eggs/spam for breakfast. Having more than 1 dish available for dinner was a sign of success. Having the best cut of beef for parties was living large. That was when eating large volumes of steak was the way to "get big" if you were a guy and girls only did 'aerobics' to burn off the calories. Creatine and protein came into vogue in the 90's, 'steroid stacks' were sold in the gym at the millennium. Now we have complex bodybuilding "herbs", TRT (testosterone replacement therapy), epo, steroid hiding drugs all abound in sports because of endorsement deals and social media spotlight. So the urgency to be the best has trickled down to grade school levels. Training hours per week have surpassed what a division I crew team would be going through on full boat scholarships. The problem arises in those little joints that haven't stopped growing yet. Placing excessive leverage on a tween joints can pull growth plates off long bone causing things like shoulder dislocations, little league elbow, chondromalacia, osgood schlatter and severs disease of the heels.
Once you find an activity of interest, be aware of how the coach treats his/her team. It is habit to want to drop off for practice and do some errands but invest some initial time in observing and make sure coach sees you. Tag team with other parents as well. I trust that most coaches have good intention especially if their own kid is on the team but don't assume. Observe the dynamics of how aggressive training is, how the ultimate concern is the experience of working with others and self improvement. Now comes the meat and potatoes of what my sister was asking.
Supplements are a good idea for an average American diet. Dr Agus was recently on a DrOz episode and brought up his perspective on no vitamins. I don't agree, average family eats OK, but usually has fast food mixed in 25% of the week (usually at school!). Just to balance the trips to any place where you cant be in the kitchen to check the type of cooking oil or choice of meat, I feel a multivitamin will "supplement" the basic building blocks for maintenance, repair and growth. I hope that with the other 75% of weekly intake coming from cooked meals at home, you may get some nutrient from the whole foods purchased from the periphery of the grocery. No no no......soil today doesn't have the same nutrients as 2-3 decades ago, more pesticides are used, more GMO seed is used, distance of shipping has been solved with airfreight so you may be getting fruits and veggies picked before ripening over 2000 miles away that never had the opportunity to complete life cycle and consequently spoil much faster on your counter. Anything that looks or feels a few hours over ripened will have degraded its nutrient content days before. May not be getting appropriate vit K, magnesium or iron especially if parents are choosing a semi vegetarian lifestyle. I don't feel we will see overt rickets, pellagra or beriberi in our schools but I do believe there will be (and already is) an abundance of unusual adult diseases popping up in childhood (reflux, depression, bipolar, diabetes type II, hypertension, high cholesterol, irritable bowel...) that were unheard of for kids in the 80's and 90's. All diseases are multi factorial and no time to discuss here but going back to basic suggestions......a multivitamin would be a start. More important for my young patients is to begin a habit of 'ritual' where the kid gets used to taking a tablet, capsule or liquid every morning. Even if the cheap kid vitamin with inferior binders just ends up in the toilet, that young person has now ingrained the idea of always taking a vitamin daily. If you try to start at teen years....get ready for resistance and failure. So for me the habit is important and starting early is important. If the little guy/girl has a medical problem then we should probably not just stick with cheap Walgreen's brand.....I would spend for higher grade vit's or get them compounded. I remember in one of the ER's I worked at there was a stark contrast in home nutrition; had a very calm easy going patient care tech that spent her whole paycheck on organic for all the kids/then her counterpart- a registered nurse who was usually stressed out and stated she attempted to feed her kids 'healthy' but it was too hard so she goes with MacDonald's and all microwave stuff because they all refused. It does take patience, planning but pays off in the long run. If it is too stressful to change diet now, OK....but all that omega 6, fructose and caffeine will have an accumulative effect sooner or later-guaranteed.
Second on my list is omega 3 oil......fish or cod liver OK! (just watch for piggy back vit A mixed in with some cod liver oils. (preformed vit A can be a problem with acting as a proinflammaotry) Again building on the idea that average kid has 50% or more of their weekly intake from fast food high in omega 6. Too much omega 6 and too little omega 3 turns on inflammation- arthritis, bowel disease, skin disease, depression......short of cooking with EVOO, eating more fish less red meat, taking the omega 3 daily will re-balance away from 'standard American diet' and more to 'mediteranean diet/antiinflammatory diet'. (in basic soccer-parent terms: given a choice of 3 days of knee pain vs 2 weeks of knee pain-diet can make the difference) Kids are sensitive to burping smells so free the capsule (the tiny one are great, call the company to inquire about if they check for mercury in product regularly) Liquid omega 3 can taste nasty.....although at the Arizona Integrative Medicine Fellowship, I sampled Barlean's pina colada omega 3 6 9 and it was yummy! (children average about 700-1200mg daily)
Last is vit D3. Due to melanoma scares, we sun-block the hell out of our kids which is good for skin cancer but bad for maintaining vit d levels in the body. Most Americans are low on vit D, there is new conflicting evidence for pro's and con's on using supplement but for the last 10 + years low levels have been associated with diseases like cardiovascular disease, asthma and certain cancers. The data on vit D toxicity(overdosing) is lacking so even if future studies say it doesn't help to keep blood levels high, it aint gonna hurt either. Until NIH and the Cochrane show anything different.....please take vit D3 for yourself and your kids. (children average about 400IU daily to be taken with healthy fat/food/oil)
So it seems like I am pushing alot of pills on kids and yes, if diet is lacking, don't wait until later. Always, always change the diet first. If you cant, then add the multivitamin and make it a habit. If there is a medical disease, clear it with the doc and add the omega 3 and D3 at the least.....other things depending on the presentation. (ie...zinc for adhd, inositol for anxiety, magnesium for dysmenorrhea, probiotics for irritable bowel, turmeric for muscle aches, licorice for reflux...) Wedge in some healthy snacks and meals into daily nutrition and hopefully they become accommodated to always seeing a fruit, veggie, or fiber source thus take it with them to adulthood. Maintain a meatless Monday and fish Friday to cut down overall sources of red meat (high omega 6 and cholesterol) and experiment with non redmeat dishes to see if they catch on. Even if training is 2 hours a day, 5 days a week (that is time consuming right in the middle of the day! God bless our parents!) the antiinflammatory diet is the gold standard for keeping a healthy injury free athlete. Eat Drink Weigh Less by Walter Willet, The Mediterranean Diet Cookbook by Harmon Jenkins (nice pics), John LaPuma's Big Book or his website for free recipes www.drjohnlapuma.com and of course my guru Andy Weil and his multiple books and informative website www.drweil.com .
(For my parents.)
