Should my son take nutritional supplements such as calcium, fish oil and a multi-vitamin? My son has a reasonably balanced diet, perhaps a little too heavy on meat and eggs (egg whites), and light on salads and fresh fruit. His height and weight are average for his age, but his parents are both tall (dad is 5 feet,3 inches [sic] and mom is 5 feet, 9 inches.), so perhaps he is a little smaller and lighter than his genetics would indicate. My wife and I both take adult supplements for calcium, fish oil and a multivitamin. What are your thoughts?

Before one can answer this question, you’ll need some assessment of dietary mineral and vitamin intake. We usually measure vitamin D levels as well and especially focus on calcium and vitamin D intake since these are associated with the same kinds of long term health problems more common with diabetes: heart disease, blood pressure, cancer.

There are more and more studies suggesting antioxidants in vitamins and minerals are important for cardiovascular health and also more and more studies documenting low levels when they can be measured. We will then recommend supplements that often are a multiple vitamin/mineral such as Centrum A-Zinc or similar once-a-day. If dietary calcium is deficient, then we recommend supplemental calcium with any of the usual combination calcium/vitamin D supplements several times a day. If vitamin D is deficient, then we suggest adding pure vitamin D as well. You can use very large doses once-a-week (Drisdol) or daily soft gels and we then titrate against sequential vitamin D blood levels to try to reach optimal levels. Nobody really knows what these should be but we try to get to the above 50 ng/ml range. If the levels stay low more than once, then we get a baseline bone density DXA scan to see if there already is osteopenia or osteoporosis. Unfortunately, this too is asymptomatic and very common.

Fish oil is more difficult since the studies are mostly in adults and while looking promising, there is insufficient evidence to be able to make a specific recommendation for kids or adolescents. I wouldn’t argue with you, however, if you wanted to add this as a supplement since the current studies are very promising. Fish oil also may be helpful with lipid problems and up to 40% or more of kids with diabetes also will have hyperlipidemia. Knowledge of family history (risks) of arthritis as well as cardiac, lipid and blood pressure problems would favor such supplements.

SB