Dr. Spock's Last Book -
No Dairy Products After
Age 2 - "Meat Harmful"
By Jane E. Brody
NY Times News Service
The late Dr. Benjamin Spock, arguably the most influential pediatrician of all time, left children and their parents with a surprising and rather demanding legacy: advice that they stick to a vegetarian diet devoid of all dairy products after age 2.
The seventh edition of "Baby and Child Care," issued last month by Pocket Books within a few months of his death at age 94, recommends an approach to childhood nutrition that many experts, including his co-author, Dr. Steven Parker, consider too extreme and likely to result in nutritional deficiencies unless it is very carefully planned and executed.
"We now know that there are harmful effects of a meaty diet," the new book tells parents.
"Children can get plenty of protein and iron from vegetables, beans and other plant foods that avoid the fat and cholesterol that are in animal products."
As for dairy foods, Spock says, "I no longer recommend dairy products after the age of 2 years. Other calcium sources offer many advantages that dairy products do not have."
Given the influence of the world-famous book, pediatricians and nutritionists have reacted with concern to Spock's new recommendations to raise children on an all-plant, or vegan, diet.
Throughout its 52-year history, "Baby and Child Care" has been the second-best selling book after the Bible. Overall, parents continue to rely heavily on Spock as an authoritative guide to raising children.
Dr. T. Berry Brazelton, a pediatrician specializing in child behavior at Boston City Hospital and a longtime admirer and friend of Spock's, called his new dietary recommendations "absolutely insane."
"I don't agree with them at all," he said.
"A vegetarian diet doesn't make any sense. Meat is an excellent source of the iron and protein children need, and to take milk away from children -- I think that's really dangerous. Milk is needed for calcium and vitamin D."
Experts expressed concern about the ability of small children to consume calories and fat to sustain normal growth on an all-plant diet, as well as the diet's adequacy in supplying recommended amounts of such essential nutrients as calcium, riboflavin, vitamin D, iron and zinc and possibly even protein.
These experts also said that having to follow a vegetarian diet free of dairy products could place undue social pressures on children, few of whom like to be different from their friends.
"Raising children on an all-plant diet can be done, but it would be like climbing Mount Everest," said Dr. Michael Georgieff, professor of pediatrics and child development at the University of Minnesota in Minneapolis.
"It would take an incredible amount of planning and balancing of nutrients."
Georgieff, who wrote the chapter on vegetarian diets in the American Academy of Pediatrics nutrition handbook, said a strictly vegetarian diet "involves very significant risks."
"It would probably provide only about 60 percent of a small child's calorie needs and maybe the same proportion of protein and would require supplementation with vitamin D, calcium, iron and zinc."
Dr. Marc Jacobson, a specialist in adolescent medicine at Schneider Children's Hospital in New Hyde Park, N.Y., said, "If a strict vegetarian diet is part of someone's long-term culture, the kids grow fine, though not as big.
"But for those who became vegans recently, I can't say it's dangerous -- but there are risks."
Starting with the first edition of his landmark book in 1946, Spock always included meat and milk products as part of a child's recommended diet.
Spock's revisions of what had been his most recent nutritional advice -- to include small amounts of lean animal foods in children's diets -- stemmed from a switch he himself made to an all-plant diet in 1991, after a series of illnesses that left him weak and unable to walk unaided.
His wife, Mary Morgan, said his health rebounded after he made the dietary change. He lost 50 pounds, regained his ability to walk and became healthier overall and more energetic, she said.
"It enabled him to revise his book before he died, which was his most important goal," Morgan said.
Dr. Neal Barnard, president of the Physicians for Responsible Medicine, a Washington-based organization that advocates strict vegetarian diets for everyone, said that he had drafted the section on nutrition in the new edition of Spock's book, but that Spock had edited it to give it "his personal touch."
Morgan said that "Ben had a hand in every part of the book" and that he was "very committed" to the diet.
"It is not difficult at all to get complete nutrition on a vegan diet if it is supplemented with Vitamin D and B-12," Barnard said in an interview.
He said diet-related problems such as obesity and atherosclerosis begin in childhood and added, "Today's kids are in worse health than ever before."
But Parker, the book's co-author and an expert in behavioral pediatrics at Boston Medical Center, objected to the stringency of the dietary advice and suggested that parents at least be offered two alternatives.
However, Spock rejected this idea, stating in a letter to Parker that he wanted his book to be "in the forefront" of the growing awareness of the link between animal foods and disease.
However, some experts questioned the need to be so extreme.
"We should be sticking to dietary changes that have demonstrable health benefits, like those outlined in the food pyramid -- that's where the evidence is right now," said Dr. Johanna Dwyer, nutrition expert at Tufts-New England Medical Center in Boston who has studied the effects of vegetarian diets on growth and development.
The food pyramid, a dietary guide developed by the U.S. Department of Agriculture, emphasizes grain-based foods, fruits and vegetables but also includes meats, poultry, fish and dairy products.
Dwyer said it would be possible to provide growing children adequate nutrition by following Spock's recommendations, but added, "Most people would need a lot of help to do it."
Nutrition experts strongly disagreed with Spock's advice to avoid dairy foods. The book states that "most green leafy vegetables and beans have a form of calcium that is absorbed as well as or even a bit better than that in milk."
But the experts noted that calcium-rich vegetables contain substances such as oxalates, phytates and other fibers that interfere with calcium absorption in the gut.
Spock also suggested calcium-fortified rice milk and orange juice as sources of this mineral that is critical to the proper development of bones.

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