Evo Terra (Host): They're cute, and now they're chewy, but do your children need to be on vitamins or supplements? Let's find out with Dr. Mark Corkins, the Division Chief of Pediatric Gastroenterology at Le Bonheur Children's Hospital.

This is The Peds Pod by Le Bonheur Children's Hospital. I'm Evo Terra. Thanks for joining me today, Dr. Corkins.

Mark Corkins, MD: Hey, it's a delight to be here.

Host: So before I ask the rather obvious questions I have about supplements, can you talk about why vitamins and nutrients are required by a child's growing body?

Mark Corkins, MD: Well, I mean, actually, vitamins are named VITA-min because they're vital for life, and they're vital for certain metabolic processes. You know, our body is a very complex soup of a whole bunch of chemical reactions happening all the time, and the vitamins are part of those, some of those reactions that take place literally the way our body works, and so they're vital, and that's why they're VITA-mins. Now, for me and you, we need them day by day. And if we don't have them, something goes wrong. Children, it's even more crucial because they are forming organs, forming tissues, they are still growing. The human brain grows and develops until about age 21. So, it's amazing that during that whole time of growth, if you fall short of some nutrient, you might affect the final outcome. And as parents and grandparents and just in general, we want our kids to be the utmost, best, healthiest. I mean, to be honest, it's kind of selfish in a way, because they're going to have to take care of us someday.

Host: Right, that's very true. Yeah, we want them to be around for that obviously, right? So, we know that kids need vitamins and minerals. It's just a part of the body. They're human and they need it for growth. But What about supplements? I mean, do kids really need to take supplements?

Mark Corkins, MD: Well, I'm going to give you a mixed answer, okay? If we ate a perfect diet, in perfect amounts, at perfect times, we wouldn't need any supplements.

Host: Right. Just like all kids do. They always eat everything on their plate, all the green things. Totally done. Easy. Okay.

Mark Corkins, MD: Oh, that's right. And ______ listening, but the Corkins household can be chaotic sometimes. We are always going, moving, going somewhere, doing something, and it pains me to admit that even as a gastroenterologist that talks and learns and studies nutrition, I don't eat perfectly. And so because of that, supplements can help make up the gap. And so, it's one of those, you know, in a perfect world, you wouldn't need them. But in reality, we probably do.

Host: Yeah, because you're right. We have yet to make a perfectly balanced pizza. If they did that, problem solved. But we don't live in this world, right? So yeah, chances are your kids are going to need supplements anyhow. But are there any tests or maybe assessments to find out, I guess, how badly your kids need these supplements or should you just start giving them supplements right away?

Mark Corkins, MD: Well, there are tests. You can test for almost any nutrient. But to be honest, the common multivitamins that are available are designed to be a supplement. They are designed to be complete replacement. And so, supplements are designed not to be in a dangerous range where they're going to cause you to have some sort of an overdose if you get too much. And they're going to fill in the gaps in case you fall short somewhere. And so, a good, basic multivitamin is actually probably a very safe way to make sure you're filling in those gaps.

Host: But I want to make sure everybody listening understands that it's filling in the gaps. You still need to get your kids to eat and do your best to get them to eat properly. Is that a fair statement?

Mark Corkins, MD: Yeah. It's a supplement. Yes, you want to eat. Again, the goal, I am a pediatric gastroenterologist who, again, studies and learns about nutrition. My wife is a dietician, and my kids, I still remember when my one daughter was kind of like, "Why do we have a vegetable every meal?" But when she was a high school senior, went to party, and she came back just aghast because they had pizza and french fries. That's what they were doing. And she was, "Where's the vegetable?" So, they sort of get it. But we try, but we're not perfect. I'm telling you, we're not perfect. And so , we are offering supplements a supplement.

Host: Yeah. Come to think of it, so do I. But getting back to people a couple of years younger than us, or many decades younger than us, what do you see as a gastroenterologist? What kind of common vitamin, let's say, deficiencies are you seeing in your patients? And what specific supplements should help with those?

Mark Corkins, MD: Well, so, again, the biggest ones we see are iron and vitamin D. Iron is one of the most crucial. It, the statistics tell us, is the number one worldwide deficiency. So, it is the number one, any population group in the whole world. Now, iron does a lot of things, okay? Probably the most crucial thing is though, it's crucial for making hemoglobin. That stuff that circulates in our red blood cells, and enough. The most common symptom you see is a little anemia. And if you're not having enough iron, you get anemic. The old-fashioned term is you get peaked. You just don't have no energy. Now, I'm using an old school term, peaked, but you don't have the energy. You don't feel up to snuff because you're anemic. And we see a lot of that in kids.

Now, part of that is because the best source of iron often is things that people try to avoid nowadays, like lean meat. You know, there are iron sources in vegetables, but they're not as widely available. So, that's why like the American Academy of Pediatrics recommends, you know, a couple of servings a week of some lean red meat. Now, again, not every day. Again, there's a balance, but iron is the big one.

The other one is vitamin D. Now, D is crucial because that has to do with calcium and phosphorus absorption and metabolism, and that's bones and skeleton. Forty percent of the skeleton you will have the rest of your life is laid down by age 16. Our skeleton continuously renews. It'll break down and it'll remake bone and it does that our entire life. But 40%, almost half, is laid down by 16 years of age. Gosh, if you don't have enough vitamin D and you're not making a good skeleton or making a good teeth, you're stuck with that the rest of your life.

Host: Yeah. Bad scaffolding doesn't sound like something you want to walk around with.

Mark Corkins, MD: No, no, no. There's a lot of concern, to be honest, that if we don't do better with our vitamin D, we're going to have a whole generation when they're 50, 60 have what they call the old Dowager's hump where they have the skeleton in the spine where they have osteoporosis.

Host: We call that the weavers hump in my family because that side of the family were the ones that tended to not do quite as much good with the vitamin D. Great information about that. I want to think about some common conditions. I think certain medical conditions that are common in kids, asthma, which I had as a young person, of course, autism, any specific supplement recommendations for things like that?

Mark Corkins, MD: Well, again, it depends on the disease very much what you worry about. For instance, in some lung diseases, there's some vitamin A may help. Again, not a whole lot of literature, just a little bit, but enough of a hint that maybe vitamin A might be a little helpful there in pulmonary conditions. And vitamin A, we used to think about it just for vision, right? Vision, it's good for your eyes, and it's crucial. And if you get vitamin A deficiency, you get color blindness, night blindness. But then, somebody did a big study, international study, and they found out that patients who were vitamin A deficient had a higher likelihood to die when they got measles. And so, they started to look and vitamin A is a crucial part of the immune system as well as our vision. So if you have something where you need your immune system work well, you need a good level of vitamin A.

Host: Yes. Yes. That makes sense. Anything for autism? That's a concern for many parents these days.

Mark Corkins, MD: Well, now, this is a which came first chicken or the egg question, okay? Autistic kids, there's no known deficiencies that lead to autism. However, autism is a disorder of interacting with the environment, and it's a social interaction issue, and they tend to have dietary selection. Let's just put it that way. They tend to be a little picky because the way they're wired, and having done this many years, I've seen people two autistic children who would only eat white foods. They would eat ice cream. They would eat chicken. They would eat popcorn. They would eat mashed potatoes. If it was white, they would eat it. Now, if you think about a diet though that's only got white foods, you need a nutritional supplement because you are deficient in some things.

 right now, again, as of today, I can tell you as of today, there's no known, "Hey, if you're deficient in this, this causes autism." We don't have _____.  But there's a lot of literature that kids who are autistic and have a diet that has a limited intake definitely need some supplementation. Ideally, you would look at what their diet contains, and you would kind of try to fill in the gaps the best you can, or they really fall short.

Host: Well, going back to this idea of filling in those gaps and you never know what your kid's eating and what they're not eating sometimes other than the one meal or two meal you prepare them at home. Look, there's a lot of things on the market. There are a lot of vitamins, there are a lot of gummies, there are a lot of dissolvables, all the various things. How are parents supposed to navigate the mass advertising and in shelves in a grocery store? How do they know that things are good and safe for their kids?

Mark Corkins, MD: That's a good question. The majority of the ones that are, to be honest with you, the ones you know are the ones you can trust, okay? It was actually looked at a few years ago, and at least from the literature, the best, believe it or not, is Flintstones Chewable. And the second was Centrum Jr.

A little caution about gummies, gummies are water-soluble, So, there are different kinds of nutrients. There's water-soluble vitamins, fat-soluble vitamins, and minerals. The gummies, being a gelatin, are great for water-soluble vitamins, but you really can't put a mineral in a gummy because then it wouldn't be a gummy.

Host: Yeah. A little harder than that.

Mark Corkins, MD: Yeah. So that's why the chewable chalky ones are the ones that are more complete.

Host: The ones we had as children, right?

Mark Corkins, MD: Right, that's right. Now, the gummies taste better and you can get the kids to take it better. Of course, the downside of the gummies too is it seems a lot like some of the candy we gave out at Halloween. And you have to worry with some vitamins about getting too much. If you eat a whole jarful, there actually are some vitamins that can have some toxicities at very high doses. A wide range where it's safe, but again, there comes a point where actually, you can get a little too much.

Host: Yeah. Not a good idea to eat a bag of Haribo gummy bears, and it's an even worse idea to eat an entire bag of gummy vitamins, because... Yes.

Mark Corkins, MD: Right. Yeah. Yeah. The chalky ones, unfortunately, are more complete because they will tend to have your minerals in them.

Host: Let's take moment, and you're a gastroenterologist, which means guts to me. What about probiotics? What kind of a role do they play in a child's gut health? And do we need to supplement with probiotics?

Mark Corkins, MD: Well, probiotics are living bacteria and they try to manipulate the flora. We all have 10 to the 12th bacteria living in our colon. And so, it is adjusted by many things. One of them is your diet. Your diet will change your flora. If you eat different kinds of foods, you will get different kinds of flora. Some people seem to have a better flora than others. The probiotic idea is to kind of, I'm going to pick a flora, a flora that's associated with better health. Probiotic means for health. And the guy who developed them originally coined the term, thought that certain diets produced better flora and better health, which that hasn't changed and that was over a hundred years ago. Do we need a probiotic? Well, how healthy is your gut and how healthy is your diet? One of the things a lot of people use probiotics for is also when they get put on antibiotics, which disrupts flora. And certainly, there's great literature about using it when you're getting an antibiotic to help keep your flora intact and keep you from getting into some of the antibiotic-associated difficulties.

Host: That's fascinating. I can't wait to see more information coming out about that. As we're wrapping up here, I want to get into some age-specific guidelines you might have for when to introduce supplements to, let's go from infants toddlers, I guess all the way up to teenagers. What do you say?

Mark Corkins, MD: Well, okay, so infants, they do recommend right from the point of birth that they're on vitamin D drops, okay? There is a vitamin D supplement at the time of birth. It's interesting. We've come so full circle. We don't have as much sun exposure. Our skin will make vitamin D for us with a lot of sun exposure. We've also learned about skin cancer and sun exposure. And so now, we are trying to avoid skin cancers, and so we're trying to get less sun exposure.

So, everybody gets vitamin D at birth. Iron is so crucial, again, making those red blood cells. If you think about an infant, they double their weight by four months of age and triple it by a year. That Volume also means an increase in your blood volume. How much iron do you need if you're going that fast and that much circulation? You need a lot. And so, the recommendation is that when you start solid foods at four to six months, you need to start foods that contain iron or start an iron supplement. Right at four to six months, somewhere in there, you need an iron supplement.

Once you get kind of out of infancy, then you start to think about the toddlers in that preschool age group, the school age group, and that's again your general supplements. Teenagers, they can go to a little bit more adult type supplement. But also again, the number one spot for iron deficiency is adolescent females because they tend to not eat things that contain iron and they tend to have menstrual cycles that are poorly controlled and they have heavy blood loss. And so, they tend to have very high incidence of iron deficiency. And so, to be honest, they probably need a multivitamin that contains iron, a multivitamin with iron, especially adolescent females. That's one of the high concern groups, to be honest, that we see in pediatrics.

Host: Well, this has been all fantastic information. Anything you would like to say or offer up before we go?

Mark Corkins, MD: Do the best you can, you know, as a parent. As a parent and as a doctor, I will tell you, you strive to do your best with your kids. And if your kids don't eat a perfect diet, it's not a failure. That's why they develop supplements.

Host: That's excellent advice, Dr. Corkins. Thank you very much for being on the program with me today.

Mark Corkins, MD: It was fun.

Host: Once again, that was Dr. Mark Corkins. And for more info, please view our entire library of podcasts at lebonheur.org/podcast. That's L-E-B-O-N-H-E-U-R.org/podcast. And if you found this episode helpful, please share it on your social channels. I'm Evo Terra, and this has been The Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.