"bundling" vs. sipping and snacking

Early in June I remembered that I had a dental radiology license that needed renewing by the end of the month, and in order to renew it, I needed 30 hours of continuing education (yikes!).  Thankfully, acquiring the hours wasn't as bad as I anticipated since I was able to finish them online during nap times and in the evening.

One of the courses I took, Interviews with the Experts, Key Topics in Dentistry Today, spent a few minutes talking about parenting and children's dental health.  Although nothing that Dr. Lott shared was ground breaking, I think some of it is worth sharing.

As a side note, unlike most of my other posts where I spend time examining published research, this post is different since I will only be summarizing "expert opinion".  Expert opinion is an important way that we know things, but it is not as reliable as certain other ways of knowing.  (Sometime I'll have to write a post about the hierarchy of evidence.)  For this reason, you won't find a list of references at the bottom--I'm simply reporting on one pediatric dentist's opinion.

With that disclaimer, one habit that greatly contributes to the demise of oral health is sipping and snacking.  I'm not particularly great at controlling this in my life (to be honest, I have quite a sweet tooth), but it truly is important.  As a mom, I certainly see the appeal of feeding kids food throughout the day to keep them happy and quiet (especially when under social pressure!) but as a former dental professional I cringe inside when I consistently observe it.

The concept that Dr. Lott talked about to combat sipping and snacking was the idea of "bundling".  If your child drinks juice or eats dessert, bundle it with the meal.  Don't eat lunch, let your child play for an hour, and then offer dessert, but let them eat it all at the same time.  Don't let your child sip on juice throughout the day, but instead, treat it as a part of their meal.  One reason this is so important is that your teeth don't care that much about how many fermentable carbohydrates (e.g. sugars, starches, fruits) they are exposed to at one sitting, but rather how often they are exposed.  Perhaps think of it like a cut that you get on your hand, if you wash it and then leave it alone it will get better much quicker than if  you don't wash it but instead irritate it every half hour and rub dirt on it multiple times during the afternoon.  Obviously the illustration only goes so far, but the point is that certain foods weaken your teeth, and prolonged exposure only exacerbates the problem.  (Mayo Clinic has a reasonable explanation of how tooth decay forms.)

Like most habits that we want to discourage in our children, it's important to take a look at what our habits are.  Take the sippy cup, for example.  Do you have an adult version of the sippy cup?  We know that it's best for the toddler to not carry a cup with juice in it around all day, but do I do this in my adult way? I prefer to sip on coffee throughout the morning, but really, I ought to bundle it with my breakfast, or at least drink it in one prolonged sitting when I'm doing my morning devotions.

When thinking about sipping and snacking, for me, it's not just the immediate disadvantages that bother me, but it's the habit that you're fostering, a habit that your child may struggle with for his entire life.

Vitamin D and Baby

The other day I finally did it, I bough a vitamin D supplement for Baby.  I still feel slightly guilty both for buying it, and for the fact that I hadn't bought it sooner (he'll be 6 months this week).

You see, I've known for some time that the both the American Academy of Pediatrics and the Center for Disease Control recommend a 400 IU vitamin D supplement for exclusively breastfed infants.  We were also sent home from our stay in the NICU with multivitamin drops I was theoretically supposed to mix with formula or milk and then feed to Baby.  Well, I wasn't going to give Baby formula, and it just seemed so inconvenient to pump just to turn around and immediately give a bottle-- it seems like so many extra, and unnecessary steps.  I know our wonderful pediatrician mentioned the need for vitamin D at one point as well.  So, yes, if my son has a vitamin D deficiency it is solely my responsibility.  And therefore, as you could guess, this is why I feel guilty for not having bought it sooner.

But, I'm stubborn.  I don't like supplements-- you could say it's a pet peeve of mine.  I feel like I ought to be able to get all the vitamins I need from my diet and a healthy lifestyle (spent anytime outside lately for your vitamin D?).  The only time I've even semi-consistently taken vitamins or other supplements is during pregnancy.  I suppose all of the hype surrounding neural tube defects and folic acid influenced me and I decided the potential benefits outweighed the risks.

To take the time and thoroughly research vitamin D supplementation has been on my mental to-do list since shortly before Baby was born, but to be honest I still haven't really gotten around to it.  By purchasing the supplement I feel like I caved in to pressure and am conforming to the norm without knowing if this is really best.  I know this is silly, but this is how my mind works...I want to know why, and just knowing that it's recommended isn't enough.

On an unrelated note, the supplement contains artificial coloring.  I asked the pharmacist if it were possible to find one without artificial coloring, and she seemed skeptical.  Even the supplements she had behind the counter contained artificial color.  Perhaps there is some available somewhere -- I'd love a link if you know of a place that sells some.

That said tough, after considering what I know of the benefits and risks, I've decided to swallow my pride and add the vitamin D supplement to Baby's diet, even without actually doing the research myself.  Perhaps this is keeping with my evidence based theme, or perhaps not.  I could see it both ways.  At least I've 'fessed up to it.

Here's hoping Baby will swallow the drops!

The weekly dose: Is there a real harm to food dye?

{Once a week we examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children.  (However, the subject could be anything that piques my interest.) You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion.  Sometimes, “more research is needed”  really is the best answer that can be given.}

Several weeks ago I was browsing my Facebook feed and noticed someone posted an article about the dangers of food dyes, and how my friend was consequently going to return the fruit snacks they had just bought.  Mentally I filed this issue in the “non-scientific hippie” folder, but was curious as to why food dyes were being portrayed in such a bad light.  I mean, I didn’t imagine that they’d be nutritious, but I didn’t really expect them to be deleterious either.  After some digging, I was surprised to find that there is quite a history to this issue.

The question that I wish to answer: Do the risks associated with synthetic food dyes warrant the removal of foods containing these dyes from a family’s diet?

As background information, the FDA regulates all color additives (1), and has for some time.  In 1966 the FDA restricted the use of many color additives due to adverse health risks, and has continued to limit the allowed color additives since then (2).  Today, there are 9 synthetic dyes that are approved for use (2, 3). However, there is concern that these 9 approved dyes are also associated with adverse health risks.

The Center for Science in the Public Interest (CSPI) published a 58 page report in 2010 summarizing many of the risks associated with synthesized food dyes (3).  In this report, Kobylewski and Jacobson examined published studies pertaining to the carcinogenicty, genotoxicity (ability to cause mutations or damage chromosomes), and neurotoxicity of these 9 food dyes.  Although some of the studies they reviewed were imperfect and lacking in one way or another, I believe it is still highly concerning the amount of evidence that suggests food dyes are associated with serious health risks. Some of these adverse risks include, tumors in multiple locations, various cancers, and an allergic-like hypersensitivity (3).   After reading the report, I agree with the conclusion Kobylewski and Jacobson reached-- that synthesized food dyes do not belong in our food since they posses no nutritive value, and are likely detrimental to our health.

To examine what else had been published, I searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed) using the search terms “food dye*” which resulted in 254 hits.  Since most of the studies Kobylewski and Jacobson referenced were either animal studies or in vitro studies (Latin for, “in glass”, these are studies that typically look only at a cell or molecule, but not the entire organism) I was interested primarily if anyone had studied the affects of food dye in a human population.  After applying a species filter of “humans” to my search, I had 61 hits-- a manageable number to look through.  After reading the titles, I narrowed the studies down to 26 articles that appeared relevant to my question.  The publication dates ranged from September, 1974 to July, 2012; apparently the safety of synthetic food dyes is not a new area of research.  Admittedly, I didn’t read through all 26 articles, but most of them were studies related to treating ADHD, and it appeared as if they were all ending up with similar conclusions.  In summary, ADHD is complicated, and we should not expect changing a child’s diet to act as a panacea, but, the elimination of artificial food dyes likely does reduce ADHD symptoms.

In 1970 Dr. Benjamin Feingold found that when artificial food additives and dyes were eliminated from the diets of hyperactive children, the symptoms of hyperactivity were reduced.  However, follow up studies during the next 20 years were less than convincing.  Because of this, interest in the effects of food additives on hyperactive children waned.  Recently though, there has been more research and public interest regarding this association.  Because of these circumstances, in 2009 the British government requested that food manufacturers remove most artificial food dyes from their products (4).  It is sadly ironic that food companies that produce food for both Britain and the US use natural or no colorings there, but continue to use artificial dyes in America (3).

In one study, the authors point out that even though controlled studies usually suggest the elimination of artificial food dyes to reduce ADHD symptoms, this is really a recommendation that should apply to the diets of the entire pediatric population (5).  Konikowska et al., (6) state that although the cause of ADHD is unknown, many studies show that nutrition is a large factor in the development of symptoms.  Although I have not read anything that suggests that artificial food dyes cause ADHD, this study again points out that many studies have shown a positive impact of the elimination of food products containing synthetic food additives on the behavior of children with ADHD (6).

So, what does this mean for my family?  For us, this means that I now consciously avoid buying products that contain synthetic food dyes, even if this means paying a little bit more for a dye-free alternative.  Previously when I read food labels I’d generally ignore the food dye information.  We don’t eat a lot of processed foods, so I didn’t anticipate this being difficult.  However, we do eat a decent amount of whole-grain breakfast cereal, and I discovered that Life Cereal has several food dyes in it (although Kix and Rice Krispies do not).  This is sad news since Life often goes on good sales and my husband enjoys it.   That said, I don’t believe food dye will single handedly give us cancer or otherwise kill us, so we intend to be level headed and still enjoy food when others offered to us-- even if it does contain food dyes. 


(1) FDA. For Industry: Color Additives. 2011. http://www.fda.gov/ForIndustry/ColorAdditives/default.htm. Accessed 1/16/13.
(2) FDA. For Industry: Color Additives Status List.  2009 (updated 2011).   http://www.fda.gov/ForIndustry/ColorAdditives/ColorAdditiveInventories/ucm106626.htm.  Accessed 1/9/13. 
(3) Kobylewski, S, and Jacobson, MF. Food Dyes, A Rainbow of Risks.  2010. Center for Science in the Public Interest. http://www.cspinet.org/fooddyes/.  Accessed 1/9/13.
(4) Kanarek, RB.  Artificial food dyes and attention deficit hyperactivity disorder. Nutr Rev. 2011 Jul;69(7):385-91. doi: 10.1111/j.1753-4887.2011.00385.x. Epub 2011 Jun 30. http://www.ncbi.nlm.nih.gov/pubmed/21729092.  Accessed 1/17/2013.
(5) Hurt, EA, Arnold, LE, and Lofthouse, N. Dietary and nutritional treatments for attention-deficit/hyperactivity disorder: current research support and recommendations for practitioners.  Curr Psychiatry Rep. 2011 Oct;13(5):323-32. doi: 10.1007/s11920-011-0217-z.  http://www.ncbi.nlm.nih.gov/pubmed/21779824. Accessed 1/17/2013.
(6) Konikowska, K, Regulska-Ilow B, and Rózańska D. The influence of components of diet on the symptoms of ADHD in children. Rocz Panstw Zakl Hig. 2012;63(2):127-34. http://www.ncbi.nlm.nih.gov/pubmed/22928358.  Accessed 1/17/2013.