Nutrition Mavens What do We think about Fortified or Enriched Foods?

[sste]

DD is now on a special diet that needs to be high in vitamin C, calcium, iron, and folate. I am still BFing but at 15 months that is not the mainstay of her diet anymore. DD is just an "OK" eater. It is a challenge to get these vitamins into her, especially C and folate.

So, in addition to my pushing fruits/veggies/lentils/eggs, what do we think of enriched breads and cereals? I have recently stopped buying my organic, sprouting bread so I can get iron and vitamin-enriched bread. Also, I was over the moon to find calcium, iron, and vitamin-enriched tofu now widely available (label tofu plus).

My vague understanding is that the bioavailability is lower in enriched foods - - you can't count on really getting 40% of your RDA from those cheerios for example. But, I am wondering if the bioavailability or actual vitamin uptake from enriched food is still significant enough for it to be a good option?

[amldaley]

The problem I see with enriched foods is that they are enriched in order to replace the essential nutrients that are lost in the refining process. Whole foods are better sources of these nutrients.

If you have a super picky eater who will ONLY eat highly refined foods, then I guess enriched is the way to go. I do this with DD specifically with calcium enriched pasta. But, in general, I would not count on it to make up a significant source of these nutrients you are trying to increase.

Have you considered juicing?

[sste]

Well, I guess what is giving me concern is that I recently bought super "whole" natural organic SPROUTING bread. And I read the back nutrition label and there is basically nothing in the vitamin B and vitamin C groups, no iron or calcium. It really seemed surprisingly nutritionally empty for something that crumbly and all natural!! At least acc to what they list on the common food label.

I have tried juicing and DD is just not a fan. I am still trying daily but it is depressing to have my concoctions rejected - - I usually try some combo of orange, a little kiwi or mango or strawberry and then a little orange juice and some yogurt. I think the taste is too intense for her. I just bought some plain yogurt as before I was adding it to fruit yogurts (which btw also have next to no vitamin C in them even if they are orange or lemon). I think I need to up my yogurt ratio.

[hillview]

We don't do enriched really. At least not on purpose. We do whole foods as much as possible. The kids are pretty good eaters through trial and error and are on the upper end of height and weight. Your dd is young. I'd keep doing what you are doing (offering lots of different things) unless she is on alert from your doc due to concerns?

[Katigre]

Why not go the route of vitamins/supplements instead?

[ahisma]

I'm not entirely opposed to them in moderation, especially in a situation like the one that you describe.

We're pretty dang crunchy (grow about half of our veggies, local organic farms for the rest, vegan, we can, dehydrate, cook from scratch nightly, yada, yada)

Still, I don't think that it is every healthy (mentally) to be a purist. If I felt that enriched wheat bread would give my DC nutrients that the ped had determined she needed more of and I was struggling to incorporate into her diet, I'd do it in a heartbeat. Heck, we eat enriched bread. It's pretty much the only "processed" food in the house, but it's here.

Calcium and iron are tough nutrients to incorporate into a toddler diet at the levels that I think you're needing...especially all at once. In your shoes, I'd go for enriched options now and gradually move to more whole food solutions as I found things that work. Moderation rocks, across the board.

[sste]

Thanks everyone! This is dr-advised but let me tell you it sounds better in theory than when you are actually trying to get a baby to eat kiwi or guava or not chuck the cauliflower.

We are doing a generic version of tri-vi-sol plus iron and then I am adding a liquid folate supplement. And I am supplementing myself to be sure about my breastmilk.

But my amateurish understanding is that it is best for the vitamins/iron/calcium to be fed throughout the day so the body can absorb better. So, it is the meals I am struggling with. I wouldn't replace eggs or spinach or yellow pepper or something with enriched cereal. But DD demands a certain amount of bread and cereal a day and she loves tofu which is why I was so happy to find fortified.

I guess I am wondering when I feed DD her organic "whole-grain" (I kind of doubt that but anyway) cheerios knock-off and it says a serving provides 30% of the RDA of iron should I assume it is more like 10% or nothing?

[amldaley]

Well, I guess what is giving me concern is that I recently bought super "whole" natural organic SPROUTING bread. And I read the back nutrition label and there is basically nothing in the vitamin B and vitamin C groups, no iron or calcium. It really seemed surprisingly nutritionally empty for something that crumbly and all natural!! At least acc to what they list on the common food label.

I have tried juicing and DD is just not a fan. I am still trying daily but it is depressing to have my concoctions rejected - - I usually try some combo of orange, a little kiwi or mango or strawberry and then a little orange juice and some yogurt. I think the taste is too intense for her. I just bought some plain yogurt as before I was adding it to fruit yogurts (which btw also have next to know vitamin C in them even if they are orange or lemon). I think I need to up my yogurt ratio.

Apple juice. Ya gotta go with apple juice as the base at first.

Try buying a bottle of Naked Juice Green Machine and see what she thinks. They also have one that is specifically Vit C boosting. If she goes for it, they basically give you the ratios you could experiment with on the back of the bottle.

I also just to straight smoothies for DD with frozen strawberries and (b/c she is dairy free) soy milk and a scoop of ground flax seed in it. She sees it as a dessert.

[maestramommy]

We do a combo of everything. When the kids do get cold cereal it's enriched. But usually they eat steel cut oats with frozen berries. That's one example. Generally we eat whole foods, but we do also feed them processed foods on a semi-regular basis, at least until my conscience can't take it anymore and I come up with some homemade version. Like, they were eating Lunchables in the car, in the school parking lot before K dropoff for 3 Fridays in a row. Then I bought some lunch boxes and started packing my own. They have also been eating those microwave Che Boyardee pasta at church before school dropoff (at church!) every Monday for a month now. But starting tomorrow I'm making them pasta with meatballs and sauce and packing it in take and toss bowls before we leave the house. The meatballs are frozen, the sauce is from a jar, but I'm trying........

And we take multis, Vit C, Tums, and fish oil.

[ahisma]

For smoothies, have you tried banana based ones? I'm not opposed to adding high quality chocolate in there either. When you eat the good stuff, you get to eat the tasty stuff too;)

For tofu, what sorts of things are you doing with it? You can do some rockin' things with tofu, I used it to make a delicious blueberry cheesecake recently.

[amldaley]

For smoothies, have you tried banana based ones? I'm not opposed to adding high quality chocolate in there either. When you eat the good stuff, you get to eat the tasty stuff too;)

For tofu, what sorts of things are you doing with it? You can do some rockin' things with tofu, I used it to make a delicious blueberry cheesecake recently.

Yeah - half a frozen banana in a smoothie does wonders for it!!!!

And silken tofu in a smoothie works well too. A female Marine Colonel I used to work for did a banana + 1/4 cup silken tofu and a teaspoon of honey every morning. It was the recipe that got me started on smoothies.

[ellies mom]

Just to clarify, enriched foods are foods that have had vitamins and minerals added to replace those lost during processing while fortified foods are those that have had vitamins and minerals added in addition to those lost during processing. Examples of this is the folic acid that is often added to bread, vitamin D added to milk and iodine added to iodized salt.

For the most part, I prefer our nutrients to come from whole foods and I don't typically buy something because it is enriched (fruit snacks for example) but I don't mind that my beloved whole white wheat bread or milk is fortified. And I fully confess to sticking a handful of cheerios in front of a certain child every chance I got because it was fortified with iron and she fought the drops too much.

[sste]

Yikes, am editing. I think I meant fortified - - or at least partially fortified and partially enriched??

This is really not my strong suit.

Thanks for the apple juice and frozen banana recs. I am bending my normally anti-juice ways on this one. :)

Ahisma, we usually saute our tofu and we eat a ton of it - - we all really like tofu. The thing about tofu is that I believe it has all sorts of great anti-cancer things in it but actually no vitamin c, iron, vitamin b, folate, or calcium. That is why I have been buying the fortified (thanks elliesmom). I am intrigued by blueberry tofu cheesecake though!

[daisymommy]

I think you were given great advice already, so I don't have much to add to that. Other than yeah, do whole foods when ever possible, but when a child's health is suffering in one area and they are picky and you have done your best...you do what you have to do sometimes. But I agree that synthetic added vitamins and nutrients are not as bio available as the real natural thing (same as you guessed).
DS #1 has an eating disorder due to sensory processing disorder and the medication he is on suppressing his appetite. So, we give supplements to help bridge the gap. I normally wouldn't, but in his case, I need to do something to help him along.

What I did want to add about the bread is, there are only a handful of certain vitamins and nutrients that the FDA has decided we should have to measure and count out on labels. So just because there aren't high numbers on the package in those given categories doesn't mean it's worthless.

Also, bread isn't supposed to be high in vitamin C or calcium. I wouldn't be shocked to see that. It would be like being surprised that your milk isn't high in fiber...know what I mean? That's just not "it's thing". Look in other areas for fortification of vitamin C and B. Like apple juice that has 100% of the RDA for Vit. C. One cup a day isn't going to hurt her, if thats a way she will take it, and she needs more of that vitamin (per the Ped.).

But what brand of bread did you buy? It should have nearly the same amount as any other true whole-wheat bread. Check out Ezekiel bread.

[sste]

I bought a whole foods bread similar to ekeziel. And then tonight I checked out ekeziel at TJs. Even with Ezekiel what you lose is the iron and calcium fortification. Normally I wouldn't be so insistent that every meal be packed full of iron, calcium, vitamin C and B (oh I forgot D earlier, D is on the dr's list as well). But, DD chucks so much food and is so temperamental that I basically have to hit every meal with these nutrients to ensure that she is getting these vitamins and minerals into her multiple times per day (including her liquid supplement).

This whole thing is very trying. We are moderate types, fairly healthy eaters and I have always "not pushed food" on the kids. But, now both this diet and the health issues accompanying it are stressors - - my heart just sinks whenever my kale soup or spinach eggs or whatever gets chucked overboard from the high chair.

[mikala]

Can you ask your pediatrician for a pediatric nutritionist consult? A nutritionist can help you brainstorm foods your child high in those vitamins that a child might accept and can help you understand the combinations that work well. For example, vitamin c helps iron absorption but calcium inhibits it.

We went through something similar and I definitely feel your pain. It's so hard to try to feed your picky child well when all of the calories count in a different way.

[ahisma]

For kale, have you tried kale chips?

Truly, my DC have been fed kale since they started solids and it can still be a battle some days. Heck, they plant it, nurture the seeds, transplant it and water it all summer long. It's still not what they want on their dinner plates some days.

IMO, doing what you have to do to avoid making eating a battle is important. I'm not saying that you stop offering your ideal options. I'm just saying that there is something to not making it all or nothing.

[sste]

Can you ask your pediatrician for a pediatric nutritionist consult? A nutritionist can help you brainstorm foods your child high in those vitamins that a child might accept and can help you understand the combinations that work well. For example, vitamin c helps iron absorption but calcium inhibits it.

We went through something similar and I definitely feel your pain. It's so hard to try to feed your picky child well when all of the calories count in a different way.

Thanks this is a great suggestion - - I am going to try to get a name. When you say calcium inhibits iron would your rec. based on your experiences be to feed calcium in a different meal than iron? This is kind of hard with a baby that is sucking down milk and yogurt all day long but I am certainly willing to try. Or is it more that you need to feed more calcium and more iron to overcome the fact that you may have some combos that are inhibiting??

Ahisma, I did try kale chips and they got chucked. I am going to try again though as sometimes it take several repetitions. I have the best luck with kale in soup for DD. However, acc. to the stuff I printed out from the internet most of the folate in the very limited number of high folate foods vanishes with cooking. In particular, I am finding folate to be a b*tch. My lists of high folate foods include things like marmite, roasted edamame, sesame seeds, dried herbs and then the things I have some hope of getting into DD like asparagus, spinach, kale, etc. all have the issue of the folate diminishing with cooking. I have had some luck doing tiny squares of the (fortified) bread, a thin layer of marmite and then sunbutter and strawberry jelly on top.

Thanks for the advice and support everyone!

[ahisma]

Sesame seeds - on cookies! make them yourself and they can be pretty healthy, really. Crackers, bagels, etc. too.

Do you have a vitamix? I think this really, really justifies one. You can puree most of this stuff and add it to food that she likes.

Here's a rockin' edamame pesto: http://www.theppk.com/2009/10/edamame-pesto-a-totally-satisfying-low-fat-manifesto/

Works GREAT as a lasagna filler too:)

Oh! If you veganize the lasagna (it's tasty, really!) you can incorporate the tofu into a cheese substitute.

[niccig]

Ok...for marmite or vegemite, which is what I eat. DS and I love it on toasted bread, butter and then a thin layer. You never want much, but just start with a tiny little bit and work up to a little more. Don't put it on thick like jelly or peanut butter. It was DS's 2nd food. You also want a lot of butter and put it on as soon as the bread is toasted, so the butter melts, and then the marmite/vegemite on top.

As I kid, I would eat vegemite and peanut butter sandwiches. Some people put a slice of cheese on top - does she eat grilled cheese sandwiches? Maybe put a little bit of marmite/vegemite on the bread and then the cheese, it'll melt and she may not notice it.

You may want to try vegemite. I prefer it. I find marmite to be very strong tasting and vegemite is less so. I think it's sweeter. The label on my jar is 100ug for 5g - that's 50% of daily amount for an adult. I had no issue with folate when pregnant as vegemite was my anti morning sickness remedy.

There are also some marmite/vegemite recipes.

there's this from Nigella Lawson - it doesn't use much marmite, but you don't need a lot of it to get lots of folate
http://www.bbc.co.uk/food/recipes/spaghetti_with_marmite_06786
I'll have to try this with DS.

[sste]

Thank you nicci! I was thinking about pming you on this topic. On my first go I just fed DD a teaspoon of marmite without my trying it first. BIG MISTAKE. My DH actually thinks I am contributing to DD being picky with my various efforts. Anyway, I am going to follow all your suggestions and try that recipe and also try vegemite. The butter and marmite sounds yummy actually. I remember thinking to myself when marmite was listed as a top food for folate how resourceful aussies are in all things, including diet. :)

[kijip]

You seem to be talking cereal, tofu and bread. I think that is fine. We do dry cereal a fair bit, usually Cherrios or Cherrio knockoffs. I agree that getting them in throughout the day is better than a once daily supplement. Gotta do what you gotta do.

Def. try juice with apple juice as the base. Will she touch oatmeal? You can add berries and flax easily but some kids hate it.

[mikala]

Thanks this is a great suggestion - - I am going to try to get a name. When you say calcium inhibits iron would your rec. based on your experiences be to feed calcium in a different meal than iron? This is kind of hard with a baby that is sucking down milk and yogurt all day long but I am certainly willing to try. Or is it more that you need to feed more calcium and more iron to overcome the fact that you may have some combos that are inhibiting??



Disclaimer: I'm not a nutritionist.

Calcium reduces absorption of non-heme (non-meat) sources of iron. From what I understand ideally we'd separate iron and calcium intake a bit. That said, it's pretty much impossible to do so with a child.

This page describes iron absorption a bit:
http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html#Causes

The flip side is that Vitamin C helps iron absorption. The classic example of this is spaghetti and meatballs. The tomato sauce helps your body absorb the heme iron in the meat balls. Vitamin C also helps with absorption of non-heme iron such as that found in spinach or beans (or organic whole-grain Cheerios...) So you'd probably get more nutritional bang from serving her fortified cereal with a side of strawberries or pineapple.

It might also be helpful to ask your doctor if there's a priority for dietary intake. For example, is it most important to get the folate from diet right now because you can get your iron from a supplement? You'll obviously be trying to hit all of your bases at once but it might help to have a little more focus as you try to work more vitamins into your picky eater.

ETA: FWIW my anemic picky eater became gradually less picky as we treated the anemia with an iron supplement and a lot more meat in his diet. The nutritionist suggested the anemia might be contributing to the pickiness and while I was very skeptical at first I think she was right. I don't know if your child is officially anemic but I'm hoping things will get easier for you too over time.

[niccig]

Thank you nicci! I was thinking about pming you on this topic. On my first go I just fed DD a teaspoon of marmite without my trying it first. BIG MISTAKE.

Yeah...I won't ever do that and I grew up on this stuff. It's very strong tasting and you just need a little. Try CostPlus World Market for the vegemite. For a bit, I would have buttered toast and just a small scraping, so it's more butter than anything else, then build it up over time. DS will eat it without any problems, but DH says I brainwashed him as it was his 2nd food.

I just made myself some. The label says 5g is serving size and gives 50% folate for an adult - you'll need less that for DD. 5g is as much as I would put on it, I usually put less about 3g I would say. So keep it very small amount, much less than 3g, and work up to a little more. How much folate do kids need? I should make sure DS ates it more often.

It's also very good for a hangover because of the salt and B vitamins. You know you overdid it when the next morning you can't eat the toast, you can only lick the vegemite off the toast. Not that I've had personal experience or anything :innocent:

I'm going to make that pasta for dinner tonight...I'll let you know how it tastes. I know my mother puts it in lamb stews etc.