Ep 202: Feeding Kids Without the Pressure: Practical Plant-Forward Tips with Dr. Reshma Shah

Feeding kids well is foundational to health—but real-life meals can feel hard. Pediatrician Dr. Reshma Shah, co-author of Nourish: The Definitive Plant-Based Nutrition Guide for Families, joins Jessica to share simple, evidence-based ways to make family meals more nourishing and less stressful. We cover how to “add in” plants without power struggles, realistic swaps kids accept, why fiber is the real gap for most children, what actually keeps kids full (protein + fat + fiber), and a no-drama take on supplements (B12 for vegan kids, vitamin D for many, calcium via fortified milks, DHA/EPA considerations, and using iodized salt). Plus: how to stop feeding anxiety at the table and play the long game with picky eaters.

Dr. Reshma Shah is a pediatrician, parent coach, and co-author of Nourish: The Definitive Plant-Based Nutrition Guide for Families (with Brenda Davis, RD. To stay in contact with her, and for her free plant-based starter guide, recipes, please check out her website: reshmashahmd.com (free plant-based starter guide, recipes, and parent resources).
 

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Transcript

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Hello listeners. This is Dr Jessica Hochman. I'm excited to share that I am now booking sponsorships for your child as normal for this fall. If you have a product, service or a message that you think our listeners would benefit from, whether it's for parents, kids, healthcare or family life in general, this could be a great opportunity. You can find details on how to sponsor by checking the show notes. Just click the link that says how to sponsor an episode, and I'll let you know for a good match and get back to you. Hi everybody. Welcome back to your child is normal. I'm Dr Jessica Hochman, and today we're talking about how to feed our kids a more plant based diet. And let's be honest, feeding kids can feel frustrating in real life. There are picky phases, busy schedules and not to mention all the conflicting advice out there, how much protein, fiber and vitamins do our kids really need? It can all feel so overwhelming, and that's why I'm so excited about today's guest, Dr Reshma Shah. She's the co author of nourish, the definitive plant based nutrition guide for families, and she offers evidence based, practical suggestions that parents can actually use. In our conversation, Dr Shah shares how to add more plants without pressure, simple swaps that keep kids full, and what supplements, if any, you should consider if you've ever wished that mealtime could feel less stressful and more nourishing. And I'll bet that's every parent listening, you're gonna love this episode with Dr Reshma Shah, and I'm hoping that this episode inspires you to add more plants into your day to day diet. And a quick reminder, before we get started, please take a moment and leave a five star review wherever it is. Listen to podcasts. Reviews help other people find the show, which in turn helps grow the community of your child is normal. Dr Reshma Shah, thank you so much for taking the time to come on your child is normal. Is normal. I'm so excited to have this conversation with you, and I'm really excited to be here with you today. So let's talk about your passion. Tell everybody about the book that you wrote and what drew you to be so interested in a vegetarian diet. So the book that I wrote, I co wrote it with a registered dietitian, Brenda Davis, it's called nourish, the definitive plant based nutrition guide for families. The way that I accidentally came to be interested in this topic is when my kids were young, I was looking at what was the healthiest, best way to feed them, and so I started to learn more as much as I could so that I could feed my family in a healthy, enjoyable way. And the more research I did, the more I came to the conclusion that a more plant centered, or a plant focused diet is really the foundation of a healthy, sustainable diet. And so I started this journey learning as much as I could, started going to conferences, and just became very entrenched in this world of nutrition and specific pediatric nutrition. And while there were a lot of resources out there for adults in this field, I didn't see a lot of great resources for parents looking for more information. That's kind of why I decided to write the book. It's true. I do think there is a lack of quality resources for families to go to. I mean, you can look at the food pyramid, for example, where the bottom is all the grains and you don't see any fruits and vegetables, unless they've made an adjustment. Yeah. So they have made a bit of an adjustment. The latest dietary guidelines, actually, for the last several years, they're more than my plate model. So we've kind of gotten away from the pyramid, which I think is a it's a good thing, because the My Plate represents like a visual representation, so it's much more practical. You can kind of see the plate. And I think the MyPlate model is a good starting point for kids, but I wouldn't necessarily stop there. So the MyPlate model has half the plate being fruits and vegetables, a quarter being some sort of grain or starch, preferably whole grains for at least half of those, and then a quarter of the plate being a protein source. And for kids, especially young kids, and for kids who are athletic and have higher energy needs, I think, like maybe not quite half the plate being fruits and vegetables, you might need to make it more third, but it's the general principle still true. That's great to hear. They've made some updates. I think that was a long time coming. So what I would love to do with you is go through why you advocate for a plant based diet, and then I would love to ask you about a lot of questions and concerns that I hear from families that are considering having more of a plant based diet. If that's okay. Yeah, that'd be great. So I think that when people are looking to eat a vegetarian, vegan or semi vegetarian diet, there are usually three main reasons that families are looking to eat this way. The first is for health considerations. We know that the more fruits and vegetables, whole grains, beans, lentils, they tend to be health promoting, and we see lower rates of chronic diseases for people who are following this pattern of eating. So I think health is a primary consideration for a lot of families. I think the second reason is sustainability. We know that animal agriculture takes an enormous toll on our planet in terms of greenhouse gas emissions, land and water use, and the more that we move towards plant sources of protein, the less of an impact it has on our environment. And the final reason that a lot of families look to eat more plant centered or plant based is for the considerations around animal agriculture and. In terms of ethics. For me, this was definitely the last consideration that I looked at. Being a pediatrician. I was primarily motivated by a lot of the health considerations. But if you really take the time to look at some of the practices, especially factory farming, there are a lot of just abuses of animals. So I think epics is a huge consideration for a lot of families. Absolutely, I am someone who does eat meat, and I can't let myself go there and think about, yeah, those ethical implications. Maybe I should be thinking more about it, but it's it's hard to think about. It's definitely a very difficult topic to look at, and I think that can be quite difficult to digest. No pun intended, yes, and I do think there are cultural considerations that I think a lot about. So for example, I'm raised in America where it's very common to eat cow, very common to eat chicken, for example. And I was recently in Iceland with my husband, and on the menu was horse. It's a very common food that is consumed in Iceland. And I had a hard time wrapping my head around the idea of eating a horse. And then I thought, Well, why does this bother me so much? If I'm comfortable eating other forms of animals, I think it is an important thing to think about. It is a life. So I do think it's worth putting value on that. Yeah, and I think the way that you're approaching this is exact right way, which is to begin with curiosity. And you're just asking yourself, look, why is it that I'm totally fine eating a cow, but a war somehow seems high appetizing, and I think if you just follow your curiosity, you're gonna land in a place that feels good for you. And you know, I'm not someone who went vegan overnight, even as I was learning about some of these ethical issues, it was a really gradual approach, and I don't think there is a exact right way to do this, but leading with curiosity and being willing to ask yourself those questions is the exact right way to approach it. I agree with that, because I'm someone who believes that small changes also can make a big difference. Like, let's say somebody's considering to be fully vegetarian, that might be a daunting process. So just making small changes, I think can lead to big changes. And I think that some people are ready to go completely cold tofu, and they're just ready to just make a big change, and especially if it's been motivated by a health consideration. And for some people, it's much more gradual. And for me, I grew up in a vegetarian household, and so the idea of eating a lot of vegetarian meals was not foreign to me, but it was a very gradual process. And I think the final step was I was entirely plant based or vegan at home, and I gave myself some flexibility if I was at a friend's house or going out to dinner or on vacation, and those small changes eventually can allow you to make the Bay of relief, and that's what I found to be true for myself. And so now I can feel totally comfortable following a vegan diet, and it doesn't feel like a sacrifice, because I think I didn't in a way that was really right for me and my family. Now, you had mentioned that there are health benefits that have been shown by research. Can you mention more specifically what those benefits are? Yeah, absolutely. I think it's really important to talk about the evidence in a very grounded approach, and not make claims that are over exaggerated or absolute in terms of this causes cancer or this does not cause cancer. So my approach is really to focus on what the evidence really does tell us, and what I can say is that people who eat a more plant centered or plant focused diet doesn't necessarily have to be plant exclusive, so it doesn't necessarily have to be vegan, but eating a more plant centered diet, we see lower rates of many of the chronic diseases, such as heart disease, diabetes, even there have been some connections to more cognitive impairment in Alzheimer's and some of these neurodegenerative conditions, digestive health, autoimmune conditions. It's very broad in terms of the scope of chronic diseases that can help to decrease the risk of developing now, can a plant based diet absolutely prevent or cure some of these diseases? No evidence doesn't suggest that, but we know that the more plant centered a diet is, the more you're including fruits, vegetables, whole grain legumes, all of these things that we know are health promoting, the more you improve your chances of not experiencing some of these chronic disease, and even people who have high blood pressure, diabetes, elevated cholesterol, can benefit from eating a more plant centered diet. And I've read as well, there's good evidence showing decrease in certain cancers, like colon cancers, too correct from eating a more high fibrous fruit and vegetable based diet. And it makes sense, right? Because we know that higher fiber diets are protective against colon cancer. Fruits and Vegetables contain many antioxidants and polyphenols that are healthy and nutritious for us and animal foods don't contain any of those plant phenols or fiber. It does make sense. I agree. I agree. So for somebody like myself, what would your advice be to get started to have a mostly plant based diet. So for families like yours, I would call you a plant curious family. And I love plant curious families because there's so many fun ways that you can explore. I think the first step is really instead of thinking about what you have to give up, where can you add more plants to the foods that you're already enjoying, and the more plant foods you start to add to your diet, your. Going to necessarily crowd out some of those animal foods. So it could be as simple as adding some fresh fruit the breakfast. You can add a cup of lentil soup at lunch, a big green salad at dinner. So where can you add plant foods in once you've sort of started to feel more comfortable with that, you can also look for a meal that your family already enjoys. And how can you make a plant based swap. So instead of doing chicken stir fry, you could do a tofu stir fry. And if your family isn't ready to go all in with just a tofu stir fry, you could add a little bit of chicken and a little bit of tofu. So you're kind of fading in those plant based foods. You could also start with something like a meatless Monday, and then make it Meatless Monday and Tuesday, or Meatless Monday, Wednesday or Friday, and kind of gradually add it in that way. So I always like to think about an add in approach, and then where can you make some really easy swaps with things that your family already enjoys? I like thinking of a meatless Monday because that's practical one day a week. I feel like I could do that. Another approach that a lot of people find useful is a vegan before six, and so that's where you eat entirely plant based the whole day. And then at dinner time, you give yourself some flexibility if you're going to include some fish or chicken or whatever the case may be. So I think just experiment, have fun with it, and figure out a system that works for you and for your family. So some common concerns that I hear from parents when they're considering adding more plants to their child's diet, I'd say the big one that I hear is a fear of them not getting enough protein. For parents that have that concern, what would your advice be? Yeah, so I think the concern is real, like you do have to plan. You want the diet to be appropriately planned. But one of the things I always remind parents too is that all diets for children, whether they're vegan, vegetarian or omnivorous, need to be well planned. I know plenty of kids who are not vegetarian or vegan, and their diet is basically mac and cheese and pizza, and I would be worried about protein for that kid as well. So I think protein is something that you do have to pay attention to, but you don't need to be obsessed with. I think studies have shown that more than 97% of kids meet the recommended protein intakes, and less than 5% of kids meet the recommended intakes for fiber. So I would be much more concerned in general, about kids fiber intake than their protein intake. Having said that, I think some simple ways to ensure that your kid is getting protein in their diet. The first is make sure they're eating enough calories. I think if you're consuming enough calories, you're likely going to meet your recommended protein intakes, and then try to make sure that you're including a variety of protein forces at most meals and snacks. Now, all of us have had the dinner where it's just pasta and you don't necessarily get a lot of protein, and that's okay, but I'm talking about on a consistent basis, make sure that you have a good source of protein most of your meals and snacks. So it could be things like tofu, tempeh, even some of the veggie meats, beans, legumes, lentils, chickpeas, even nuts and seeds are going to have some protein in them, as well as whole grains. So think about, Do I have a source of protein at this meal or snack? And if not, how could I add one? Easily. I'm also curious what you think about this. I feel like our society has become protein obsessed. There's the idea that they have to have chicken and meat to get enough protein, they need to have protein at every meal. And from what I've read, kids only need to have about 10 to 15% of their total daily calories to come from a protein source for them to meet the sufficient needs for a growing child. And even then, they don't need to have it every day. If they don't have great protein one day, they'll make up for it the other day. And kids often tend to crave what they're lacking. I believe, yeah, so I do also think that we're overthinking protein for kids to grow and thrive sufficiently. I do think that our obsession with protein is at a peak. And like I said, I think we should be focused on low calorie fiber. I think that if kids are getting adequate calories and they're eating a variety of foods, and if you have a really highly selective eater, you might have to pay a little bit more attention to it, but if they're eating a variety of food and they're getting enough calories in their diet, it's highly unlikely that they're not going to make their protein intakes. There was a group of studies done out of Germany in the early 2000 20s, and they looked at protein intakes of vegan children, vegetarian children and omnivorous children. And it is true that the omnivorous children had higher protein intakes than the vegan children. All three groups almost had double the recommended intakes of protein. So everyone was meeting their protein intake. So generally, if they are eating a variety of foods and they're eating enough calories, I'm usually not concerned about protein intake for my vegetarian vegan families, right? The real struggle, I find, is to get those nutrient based foods like fruits and vegetables in their kid's diet. So that leads me to my next question. A lot of parents struggle getting their kids to eat fruits and vegetables. Specifically, vegetables are really tricky for parents. Do you have any advice for the picky eater, where kids don't want to touch a vegetable? What would your advice be for that family? Yeah, and I think that it's really understandable, and I have a lot of compassion for families that are struggling with this issue, because their concern is coming from a really valid and a good place. They're worried that their kid isn't getting the nutrients they need to be able to grow and develop well. And the problem I often see is that really. The understandable concern gets dialed up and it gets turned into anxiety. Once anxiety has come to the dinner table, it's a whole different ball game. And you know, parents end up using a lot of pressure tactics, either negotiating or bribe, saying you're not going to get your dessert. And while I understand why parents use these tactics. It ends up backfiring in the long term. It actually can work in the immediate term, if you're sitting with a kid and you say, unless you finish your broccoli, you're not getting the chocolate chip cookie, chances are the kid will end up eating the broccoli. But in the long term, it actually doesn't work, because it just escalates and escalates, and you've actually unknowingly taught your child that the broccoli actually isn't worth eating and of itself. So I think the first step is just checking in with your own anxiety. Have you invited anxiety to the table? Are you using some of these pressuring tactics to get your kid to eat more? Fill in the blank broccoli, lentils, whatever the case may be, and if you are, it's okay. You haven't ruined anything, you haven't messed anything up. But the first step, I think, is really working to take away the pressure. And it's going to take a while. If these patterns and habits have developed over time, it's going to take some time for them to unwind themselves. But I find, in general, as long as there isn't a specific feeding disorder or underlying neurodevelopmental issues or medical conditions that really are interfering with the child's capacity to eat a variety of foods. Once you improve the dynamics around feeding at the dinner table, it's more of a last and gradually, they will start to eat more of these nutritious foods on their own. And I always say, parents, you're in it for the long day. You want your kids to be making these choices around food, not just at your dinner table, but when they're away from your dinner table. And I can sing it with my son, who is in college now, misses vegetables. He comes home and he says, I'm not eating enough vegetables at school, you know? And I'm not saying that to boast or bribe or anything he has is definitely my more selective eater, but I think he's been taught to be able to enjoy these foods in and of themselves, and he doesn't require the promise of a cookie at the end of it to eat them. It's very true. I find this statistic interesting in reference to picky eaters. When you pull parents of two year olds, 50% of them will say that they have a picky eater. So it is normal for toddlers to be picky eaters. And I think that's the hard part for parents, is to look to the long game. Because I agree with you, if we can foster a supportive family environment around the dinner table, where we offer those foods but take the pressure away somehow, without making it feel forced, I think eventually that pays off. Yeah, I think my general approach to feeding is I have a caring but not catering approach. So what I mean by that is my goal is for you to enjoy dinner, and I want you to look forward to the meal and find it to be really tasty and all those things. And so I'm gonna do my best to like, take the family preferences and considerations, but I'm not gonna cater. And so I think some of these habits and these routines around dinner, you have to have a goal and a vision. At the onset of I want this to be an inviting, nourishing environment for my family, and if you practice that with consistency, it does get easier. And for the kids, where you're reading a lot of resistance, if it's beyond the garden variety to eating, I really like for parents to get support earlier rather than later, because the longer that they are going without support, the more that these unhelpful habits can really make themselves firm and established at their dinner table. I've also heard you reference Alan sodders approach to feeding kids at the dinner table. Yeah, and I think her approach is really at the foundation of a lot of feeding dynamics, and I think it's a really good framework. I often tell parents to feel free to personalize it, because I think nothing is going to be a one size fits all model. And actually children with specific temperaments, I always say I have expertise, that the parents are the experts of their family and their child. And so her division of Responsibility framework basically says that both parents and children have a set of responsibilities when it comes to eating and feeding, and you want to make sure it's Senate developmentally appropriate framework. But basically, parents decide the what, the when and the where feeding. So you might decide that we're having tofu stir fry at six o'clock at the dinner table, like that's that's our lane disdain. And then it's up to the cat child, in a developmentally appropriate way to decide how much and whether they're going to eat the foods that are served. And that part really scares parents, because they often worry if I let my child decide whether they're going to eat the foods, their decision is going to be no if I let my child decide which foods they're going to choose, they're only going to choose the pasta. And you mentioned that kids crave the nutrients if they're missing, and I do believe there is some truth to that, and it's true for a while, they might just end up eating the pasta and the rice and the bread, but eventually, if you really stick in your lane and you're not pressuring and you're not forcing, they will have the capacity to be able to eat a more well rounded diet. And if we're feeling. Lot of resistance at the table. Ask ourselves, Am I in my lane, or have I crossed over into my child's lane by prompting them to eat more broccoli or eat more carrots or whatever the case may be, one of the more common concerns I hear from parents when it comes to eating at the dinner table is this fear that if they don't eat dinner, they'll go to bed hungry. And that really doesn't sit well with a lot of families. So what would your advice be to families? If that was a scene at the dinner table where you offered it, you made it available, but the child just refused the tofu stir fry for dinner, should they then make a second meal? Should they offer some fruit? What should the boundaries be? I think this is where caring without catering really comes into play. Know your child, is this a chronic, recurring thing, or is this like a had a bad day and they just need a little extra support, or maybe an extra snack? I think one rule of thumb that has been really helpful is, don't make the snack more enticing than the dinner. So if the snack is going to be, I don't know, fill in the blank cookie, chocolate chip cookie. Of course, I'm going to say I'm not hungry for the dinner and get to the chocolate chip cookies. So I think the blanket answer of stick your dimes, don't give them a snack. I think in practice, it's really difficult if your kid really is hungry and they need a little extra support. But you know, one option could be, I saved dinner for you. I'm happy to re warm it for you, or just not trying to make that snack more enticing than the dinner itself. And if it's a chronic thing, like you may have to look at your meal times, maybe they're having a really late afternoon snack and that's interfering with their appetite at dinner. So be a little curious as to why this is happening, and then really try to tailor your response to what's happening for your child. And I completely agree with you that nuance matters. Every family dynamics different. Our approach to what we feel like is a good balanced meal, the traditions and what foods are prioritized may be different from families, and so I do agree with you that nuance really makes a difference. Yeah. So my question for you is I tried with my husband for a short while to follow a vegetarian diet, and what I found was I was craving a lot to feel full, and then I found that I was eating less healthy than I typically would. I was having a lot of bread, I was having a lot of pasta, looking for foods to fill me up, because the fruits and vegetables weren't doing the trick for me. And then I found for myself, having more meat in my diet. I actually do find that I eat healthier in a way. What would your advice be for someone like myself who's looking to eat less meat, but I also want to make sure that I do it in a healthy way? Yeah, and I think it's a great question, and I think a gradual approach can work really well for some people, because you have time to tackle me and discover what really feels satisfying and nourishing. The common mistakes I find when people are going plant based or wine eating or wanting more vegetarian, first is, oftentimes they're not consuming enough calories. I would never discourage anyone from eating fruits and vegetables. Go for eat as many fruits and vegetables as you want, but they're not very filling. So you want to make sure, like, in my mind, a kale salad is not an adequate lunch, you want to make sure that it has some roasted chickpeas, or some tofu, or some pumpkin seeds, a good tahini dressing. Things that are going to have fat, fiber and protein, those are the things that are going to feel satiating to you. So you want to make sure that your snack isn't just an apple, because I would be hungry after that. So making sure that it's got protein, fiber and some healthy fats in your meals and snacks, so that they actually feel filling and satisfying is really important. So make sure you're eating enough calories. Add those things in. And I think the bottom line is, make sure you're eating enough calories, and don't be afraid to add healthy fat, sources of protein and fiber that are going to make it a little bit more I think that's fantastic advice, and you're probably right. I probably wasn't getting enough calories from the legumes, from the fats, from the nuts, so that I wasn't craving so many simple carbohydrates. Yeah, I think this will be a really fun way to get the kids involved. Have some excitement. We're doing Meatless Monday. What should we try this week? Make them excited for it too. It's great advice. Okay? And then another question that I probably hear from parents multiple times a day is whether or not consuming a vitamin or a supplement makes a difference. Parents worry that they're not going to get the nutrients that they need. Would you recommend a vitamin for a kid in that situation, or can they get enough if they're having a well balanced plant based diet? So it depends on a couple things. It's going to depend on how plant based they are. So for families that are flexitarian, where they're eating mostly plant based, but they are consuming some dairy, some fish, some eggs, some animal products throughout the day, that kid's needs for supplements is going to look different from a child that's following an entirely vegan or plant exclusive diet. So there are some specific needs for supplementation. The other thing I remind parents of though, is every child may or may not need supplements, depending on the diversity of foods that they're including in their diet, and I can give you some specific examples. So for kids that are vegan in a plant exclusive diet, they need to make sure that they're getting an adequate source of vitamin B 12. And the reason for that is B 12 is found in animal source foods. It's actually B 12. Is found in bacteria in the soil, and when the animals grave on it, that's how they get it. Oftentimes, animals are fortified with B 12. Some people say, Oh, you can find b 12 in some mushrooms and things like that, but it's not a consistent and reliable source. And so the safest thing for any kid that's following a vegan diet is to take a vitamin B 12 supplement. Some foods, like the plant based melts are fortified with vitamin B 12. But you know, kids are very particular. One day they're drinking the plant based milk, and the next day they're not. And so unless you have a consistent intake of these foods, the safest thing is to take a vitamin B 12 supplement. That one's non negotiable, and the reason for that is the impacts of having a vitamin B 12 deficiency can be pretty devastating, especially for young, developing children, the good news is that vitamin B 12 supplements are pretty inexpensive, like no risk of side effects taken at the recommended intakes, and they're pretty easy to take, so that one's kind of a no brainer. Something else I'd like to mention about vitamin B is that it's water soluble, so if a child does take too much, the body will urinate the extra. So you can't really overdo a vitamin B 12 supplement, correct? Yeah, and there are some formulations that are super high doses, which I would not recommend for kids, but if you're taking them in the recommended doses, I have zero to no concern that a vitamin B 12 supplement is going to be harmful, and then the rest of the supplements are going to be a little bit more nuanced. One that I find that a lot of kids need this vitamin D, and the reason for that is, even you're drinking cow's milk, if you're drinking the amount recommended by the AAP, you're still not going to meet your vitamin D requirements for the day. And with sun exposure, we're trying to limit it in terms of sun protection, we're wearing sun frame, and especially with the latitude that you may live at, the sun isn't always the best source of vitamin D, so a lot of kids may actually require a Mindy supplement, regardless of the type of diet that they're following. So that's another nutrient. And some of the other nutrients that don't necessarily require supplements, but that they do require some closer paying attention to, is calcium. And again, this is a nutrient that not just plant based kids, but even if you have families where the kids aren't drinking a lot of milk, they're likely not meeting their recommended intakes for calcium, and so for plant based families, you want to make sure that your plant based milk is fortified with calcium. So we've covered vitamin B, 12, vitamin D, calcium, another nutrient. The data on this one isn't quite as clear, but the omega three fatty acids, so DHA and EPA, the most common source is found in fish. And again, a lot of kids aren't consuming fish regularly, so if you have a kid that's not eating fish, you might consider a tha EPA supplement. The studies are more robust for pregnant and nursing women, as well as for younger children. So kids under the age of two, I would definitely consider one. And for older kids, it's one of those things where I don't think it's harmful. And for added assurance, I would recommend considering a DHA and EPA supplement. And then one other nutrient that I think has been gaining some increasing attention of late is iodine, which might be like a peculiar one to talk about, but the main sources of iodine in the diet are dairy and seafood. And for plant based families are not including dairy, they aren't eating a lot of seafood, and if they're not using iodized salt, so a lot of these, like pink Himalayan sea salts, they're often not fortified with iodine. So an iodized salt is the best way and easiest way. But if you're not using iodized salt, you want to make sure that you're getting an adequate source of iodine, and sometimes most multivitamins will have about half the RDA vitamins. If you're doing a multivitamin and then eating regular foods, it's usually just fine. So those the main supplements that come to mind. A typical scenario that I notice is a family is not vegetarian, has a teenager who is considering a vegetarian diet to assuage the parents concerns. Do you recommend that we check labs on that child every so often. And what labs would you recommend, not necessarily the standard labs, when you screen for anemia and things like that, do the standard labs if you have a specific region to check labs, given an athlete and they're feeling fatigue, or you're concerned about iron deficiency, I definitely recommend checking a CBC. The recommendations for checking vitamin D are all over the place, like, at first, we were checking them a lot, and now they're actually saying that we shouldn't check them. But if you have a child that has consistently not had a good source of vitamin D, they're not drinking milk, they're not taking a D supplement. It's not a bad idea just to check the it's not super, super low in terms of vitamin B 12. It takes a while for the deficiency to develop. So if you've only been vegetarian for a week or two, you're not going to have a vitamin B 12 deficiency. So you don't need to worry about that. If you've had months or years of not getting an adequate source of vitamin B 12, I would check a level and actually for vitamin B 12, instead of checking just a serum B 12, which you certainly could do, checking the downstream metabolites and MMA or homocysteine, is actually a much more sensitive measure of vitamin B 12 status. So I recommend those tests over just a serum B 12. Interesting. And so if somebody does have a high homocysteine, for example, at that point, you'd recommend a vitamin B 12 supplement, correct. Oh, I don't want them to get to division C state. So if you have a child that says, I'm. Interested in being vegetarian. You don't have to wait for the lab results to start the supplementation. One time, I had a mom with a newborn who came to see me, and she was vegan, and she didn't share the information with her health professional because they were very dismissive and discouraging, and so throughout her pregnancy, she wasn't taking any B 12 supplements. So that's a person that I would check labs in, just to make sure that we're not dealing with a deficiency state, but you absolutely do not need to check a lab before starting a B 12 supplement. And in terms of calcium, blood levels of calcium are going to be very tightly regulated. The main downstream effect of calcium is their bone health. We want to prevent osteoporosis and osteopenia later in adulthood, and so checking his serum level of calcium is not to be that helpful. If there is a lot of parental anxiety, say that teenager comes in, they're really motivated, and the parent is feeling like I don't have the tools, the resources, the bandwidth, the knowledge to know how to do this safely. I think in those instances, meeting with a registered dietitian who's experienced with plant based diets, vegetarian vegan diets can be incredibly helpful, not forever, but just in the initial stages, to make sure that you're covering your nutritional basis. Now you brought up milk, which is also a very common question from parents. A lot of parents believe that their kids need enough milk to get the nutrient requirements that they need for their calcium and their vitamin D, but I'm curious what you think, because it's of my belief, that while, yes, milk does have some added vitamin D, there's calcium, there's vitamin A, there's protein, all of those nutrients kids can get from other dietary sources. So it's okay, if their kid's not a big milk drinker, they can get that calcium from dairy or legumes or green leafy vegetables. Or, should I be encouraging a milk alternative? In your opinion? Yes and no to all that you said. So dairy absolutely was not required in the diet to be healthy, to have strong bones. We know that kids, for a variety of reasons, cannot consume dairy. They may be following a vegan diet, they may have lactose intolerance, they may have a dairy allergy. So this advice and guidance is for a lot of kids, and you think of over 70% of a global population is lactose intolerant. So chances are whether the families that are vegan, you will have families that are not consuming dairy. So this information is helpful for a lot of families you absolutely do not need dairy to meet your calcium requirement, having said that things like cruciferous vegetables, broccoli, kale, tahini, sesame seeds, almonds, oranges, all these foods contain calcium, but the amount of these foods that a child would need to be able to consume to meet their calcium requirement is quite high. And I don't know about you, but I don't know a lot of kids that are excited to eat bowls and bowls of kale or bowls of broccoli. So I think for the vast majority of family, if you're not consuming dairy, you want to make sure that you're including one to two cups of a fortified plant based milk a day. And for kids who don't like to drink milk, you can find creative ways of including this. You can put it in your oatmeal. You can make it into a smoothie. Some kids actually don't mind drinking a cup of milk with their breakfast or their lunch? So I think for most kids, you do want to be looking for a dairy alternative, because it would be incredibly challenging for them to meet their calcium needs through food source as well. Now this may be a tricky question to answer, but I'm going to ask for families that are vegetable curious, or they're vegetarian curious, as you said, can you offer like, two or three pieces of advice for them to try to get their kids to be more interested in tasting vegetables? I think the first thing is to invite them into the process, you know, get their opinions and get them to come up with some ideas. We're so lucky in California to have so many amazing farmers markets. And when my kids were young, we would grow the farmers market together, and a lot of times they're offering samples, and they would try, you know, a ripe peach or a blueberry or a snap pea. So get your kids involved as much as you can. The second thing I would say is to model the behavior yourself. I cannot tell you how many parents come to me saying, my kids won't eat vegetables, and the parents aren't eating them either. So you have to walk the talk. You have to practice what you preach. Let your kids see you enjoying the vegetables too, or you be willing to try a snap pea or a food that you might not have been open to trying before. And then the third tip, I would say, is explore a lot of different cuisines. I think that so many cultural cuisines, whether it's Indian or Ethiopian or so many foods, have plant based foods. They have the staple in those cuisines. And if you try a variety of different ethnic foods, that can be really fun way to explore as well. Absolutely, I have to say, specifically my 14 year old, I'm so pleased to see how her how her diet has evolved. She was that classic, picky two year old who wouldn't touch a tomato, and we've just kept doing what you're saying. Honestly, we go to farmers markets a lot. We try different cuisines. We try to be role models of healthy eaters in our house as best we can. And now she loves pickles, she loves onions, she loves mustard, she loves spice. See, I tease my husband. We've almost made her too good of an eater, because over the weekend, we had some Japanese food, we had some Korean food, and it's not cheap. So the next step is to get her involved with cooking some of these cuisines, so you can eat at home instead of having to eat out so much. That's a really good idea. All right, that'll be our added on to our Meatless Monday. Have her help cooking, but I but it's actually been very rewarding as a parent to see that practice of consistently offering a variety of foods, putting out fruits and vegetables, and then seeing her become as good of an eater as I could have hoped. It's really paid off. Yeah, I think as parents, sometimes we can have our own fixed mindsets, right? We're like, Oh, she's a picky eater, oh, she's not going to eat that. And yes, I think a lot of times we bring that expectation, that anxiety, that legacy, yeah, and we're bracing ourselves for the battle. And it doesn't have to be no and be open to the possibility that it could change. I do agree with the idea that as parents, if we can try to avoid labeling our kids, that will serve us better in the long run, because if we're always thinking of our kid as the picky eater, as opposed to their picky for now, or they're picky for today, that will provide that environment where they're open, and we're open to them continuing to expand their palate. And I don't know, I'd be curious to know what you think about this, but I think that a lot of this really goes back to temperament. You know, you have that kid that sometimes is slow to warm, and that kid that's like the life of the party and can just go in. And I think the same applies with the food. Their kids were a little bit more cautious. They need a little bit more support. They need a little more patience, they need a little more tenderness. And then there's the kid that'll be brilliant, I'll try anything you heard and put in front and I think as parents, we really need to tune into what is my child's feeding temperament and do they need a little extra care? Do they need a little more patience? What are the best parenting quotes I've heard? You know, parenting the child that you have versus the child you wish you had, or that you hoped you'd have, can really make a big difference. It's so true. And there's another saying that I often think about, especially with the younger ones, where some kids eat to live, and some kids live to eat. And you know, I'm thinking about what you're saying about their difference in temperaments. It's true. You have to work with the kid that you have, yeah, and go from there, yeah. So this has been really helpful. I really appreciate all of this education, all the practical tips, if parents want to learn more from you and they're curious about adopting a more plant based diet in their household. Are you available for coaching? Yeah, absolutely. So I love working with parents, whether they're plant curious or fully vegan or have general questions about feeding and parenting. And the best way to reach me and find me is on my website, which is my name, Reshma Shaw, MD, parent coaching, very clever I know.com, and on my website actually also have some free resources. I have a plant based Starter Guide that kind of goes over some of the nutrients that we talked about, how to think about composing a good, healthy plate for your family. And then some recipes that are fun and I think, very tasty. And then I try to share information on Instagram, just healthy recipe, parenting tips, feeding tips, and information and resources, specifically about some of the things that we talked about. Like, how do you choose the best plant based milk for your field? I love it. And then I know you mentioned it at the top of the episode, but remind us again the name of the book that you co wrote, yes. So it's called nourish, the definitive plant based nutrition guide. And so if you are like, ready go in full tofu on the whole plant based adventure, we really wanted to create a definitive resource for families to give you all the information and the tools to be successful. Thank you so much. I've really enjoyed this conversation. I've learned a lot. I'm inspired, and I really believe that the foundation of health is not what happens when you come in to see the doctor, it's what you're doing at home, and a lot of that is the diet that we consume on a regular basis. So thank you so much for promoting health, and I appreciate you taking the time to be here today. Yeah, it's been wonderful chatting with you, and I would love to know how your meal is Monday adventure goes. Thank you so much. I'll keep you posted. Thank you so much for listening, and if you enjoyed today's episode. It would mean the world to me if you could do two things, share this episode with a friend or another parent who might find it helpful, and leave a five star review wherever it is. You listen to podcasts, it really helps other parents find the show and join this community. See you next. Monday. Bye.