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ELECTRONIC ARTICLE: Norman F. Carvalho, Richard D. Kenney, Paul H. Carrington, and David E. Hall Severe Nutritional Deficiencies in Toddlers Resulting From Health Food Milk Alternatives Pediatrics 2001; 107: e46 [Abstract] [Full text] [PDF]

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eLetters published:

Evil Health Food Industry or inadequate Health Care Industry?

Mary Fay   (11 April 2001)

Just the facts.

Norman Carvalho   (12 April 2001)

Solutions vs. Squabbles

Ned Hoke OMD, L.Ac.   (12 March 2002)

Evil Health Food Industry or inadequate Health Care Industry? 11 April 2001
Mary Fay, M.D. Send letter to journal: Re: Evil Health Food Industry or inadequate Health Care Industry? mfay2{at}home.com Mary Fay	The recent article titled "Severe Nutritional Deficiencies in Toddlers Resulting From Health Food Milk Alternatives" is misleading and would more appropriately be called "Severe Nutritional Deficiencies in Toddlers Resulting From Nutritionally Deficient Diets." It's doubtful it would receive much attention under this more accurate title, but at least it would not lead physicians to the mistaken conclusion that alternatives to cow's milk are inherently bad for children. These authors do not attempt to prove, nor do they prove, that "Health Food Milk Alternatives" cause nutritional deficiencies. They point out the importance of a nutritionally balanced diet, and if they prove anything, it is that physicians may believe in the importance of nutritionally balanced diets for children, but they often fail to impart this wisdom to parents. If parents "perceive" there is a milk intolerance that causes them to use alternatives to cow's milk and the physician doesn't address this, then most likely the parent will modify the diet and that may lead to inadequate nutritional intake. It isn't the Health Food Industry that is to blame, it is the Healthcare Industry that did not take the time to address the parents concerns. It is important for physicians to understand that one could substitute raw cow's milk, or almost any liquid, and if given in the abnormally large amounts described in this article to a toddler who refuses to eat solid foods, it will result in a nutritionally deficient diet. Unless the liquid is nutritionally balanced (toddlers do not drink formula, hence this is unlikely), you would get into trouble. It is my impression that more children suffer from poor growth and iron deficiency anemia caused by excessive cow's milk intake, than malnutrition from rice milk. This article contributes to the common misconception that children cannot exist without cow's milk, and that it is an essential part of the human diet and always good for a patient. Dairy products may have been deemed a "food group," but they are not essential nutrients. A "food group" is nothing more than a classification system aimed at helping patients to remember sources of essential nutrients. Calcium, protein, fats, sugars, and certain vitamins we add to milk may be essential to the human diet, but cow's milk is not the ideal source for these things, and certainly, it is not the only source. Drinking the breast milk of another species isn't normal and it isn't necessary, and for those allergic to cow's milk, drinking the breast milk of a cow is contraindicated. I have no doubt many of the children described in the article had cow's milk allergy which improved or resolved by the time they were placed back on it by the physicians treating their malnutrition. It was the cow's milk allergy and poor medical care that caused the problem, not the rice milk. Bottom line, it is the pediatricians role to guide parents in their feeding practices and diagnose and treat food allergies - or reassure parents none are present . If there is any finger pointing that should be going on, it is at ourselves and the "preventive care" health system which serves patients so poorly that any become malnourished in a country where food is readily available.
Just the facts. 12 April 2001
Norman Carvalho, Pediatric Hospitalist Children's Healthcare of Atlanta Send letter to journal: Re: Just the facts. drnorm{at}aol.com Norman Carvalho	Title: Just the facts. Response to “Evil Health Food Industry or inadequate Health Care Industry” Dr. Fay’s plea that “drinking the breast milk of another species isn’t normal” is interesting. It was not the purpose of our report to imply that drinking cow’s milk is an essential, irreplaceable part of the human diet. However, if you do replace milk with another beverage, then it would be prudent to ensure that it is fortified with vitamin D, as vitamin D fortified milk is the chief, and only substantial dietary source of vitamin D for most humans. Additionally, in the case of young, growing children with a high recommended dietary protein allowance of 1.2 g/kg/day, milk is an important protein source. Any beverage replacing milk should therefor contain a reasonable amount of protein. The protein content in “rice milk” is inappropriately low for young children. Dr Fay provides a good analogy by comparing iron deficiency caused by excessive cow’s milk intake with kwashiorkor caused by excessive rice drink. In both instances the cause is rooted in an unbalanced diet consisting of excessive beverage intake at the expense of other nutrients. It is noteworthy that the mortality associated with kwashiorkor is high, it impairs cellular immunity and leads to serious derangements in homeostasis. It is far more serious than iron deficiency anemia. More children suffer from iron deficiency caused by cow’s milk than malnutrition from rice “milk”, because fortunately there are far more children drinking cow’s milk than there are drinking rice “milk”. Dr Fay seems to have overlooked that the second patient described in our report, who had severe rickets, consumed what would be regarded by most people as a well balanced diet, with the exception that it contained no vitamin D. This omission (of vitamin D) occurred because the child was on an unfortified milk alternative. I think one can therefor conclude that the milk alternative, in this case, caused a serious nutritional deficiency. Clearly, some children are allergic to cow’s milk protein, and in those instances an alternative to milk is necessary. I recommend choosing a substitute product that is specifically formulated for young children and which is nutritionally equivalent to cow’s milk. At the very least, the alternative should be fortified with vitamin D and contain sufficient amounts of protein. The pressures at play in modern pediatric offices may easily lead to neglecting the dietary history. I whole-heartedly agree with Dr. Fay that pediatricians should pay attention to parental dietary concerns. To not do so could potentially be a serious oversight. In fact I thought that was one of the main points of the article.
Solutions vs. Squabbles 12 March 2002
Ned Hoke OMD, L.Ac., Practice of Ecological Medicine Private practice Send letter to journal: Re: Solutions vs. Squabbles DrHoke000{at}aol.com Ned Hoke OMD, L.Ac.	Dr. Carvalho counterpoints Dr. Fay's remarks but what's left to be done, in my view, is a vision for the future that responds to the need. Imagining physicians or their agents as the future nutritional guides and teachers is sadly laughable. Here are some striking cases that indicate a world of knowledge is functionally unavaliable to the parents of these children and what follows is a little squabble about blame..What we have is a nutritionally illiterate general public, painfully evidenced in the cases presented, and no functional venue but for conventional medicial services with which to respond. Where is the pro-citizen, life-long, supporting Public Health process that has as one of it's functions routine guidance for parents of newborns? We have a society so industrialized by commerce and the false struggles of excessive consumerism that basic non-profit actualities of life are left, sometimes profoundly, unattended. While physicians can have a useful role in various ways this isn't a physician-centered problem and for doctors to sneer at the foolish beliefs of those who get their news from advertising, from so-called healthfood vendors or anyone else, or who wish for a better world when physicians became nutritionally conscious and lovingly went broke giving time to significant nutritional education..neither of these is a solution that, for me, goes anywhere.