The "Dirty Dozen" - Produce with the highest amounts of pesticides

I was asked to recap the "Dirty Dozen" list - fruits and vegetables with the highest amounts of pesticides.  I buy organic produce whenever I can, and recommend this practice for the families I see, as well.  I will also choose local produce whenever it is available at farms and farmers' markets.  Statistically, these have been shown to be lower in pesticide residue as well.

Here is the list based on 2012 studies:

1.  Apples - not a surprise, they are usually high on the list every year;  apples are also notorious for being loaded with bacteria on their exterior surface as well; organic apples are easy to find - please buy those :)
2.  Celery - a surprise for me; can't say I see much organic celery or find it often at the farmer's markets
3.  Strawberries - usually a good local find for many people; I love picking my own at the local farms when I can
4.  Peaches
5.  Spinach - yes, it is a great thing to eat; obviously buy organic if you can
6.  Nectarines
7.  Imported grapes - interestingly, domestic grapes didn't make the list - shop accordingly
8.  Sweet (red) bell peppers
9.  Potatoes - a little surprise, evidently they absorb pesticides that are applied after harvest; peel and cook them to minimize risks
10.  Domestic blueberries - another fruit that I never buy unless it is organic/local
11.  Lettuce
12.  Kale - see comments for spinach above

The normal rule of thumb for any produce is this - any fruit or vegetable that is eaten raw with the peel intact exposes you to pesticide residue.  Wash all produce well, and buy organic when you can.  I can now find organic bananas at my local grocery store, and even though bananas are seldom on the list, I buy those now.  The price difference between organic and nonorganic is pretty small in most cases.

Store Brand Infant Formulas - "Are they just as good?"

The short answer is: yes, they are -- according to recent studies comparing store brand formula with the name brand competitors. 
Store brand formulas are manufactured primarily by Perrigo Nutritionals - they produce more than 50 different global infant formulas, including those offered by major chains WalMart, Target, Babies R'Us and others (see the list below).  These formulas are made at the company's Vermont and Ohio facilities - both ISO (International Standards Organization) certified.  Perrigo Nutritionals is 1 of only 4 FDA inspected US Infant Formula Manufacturers.  This means that they have a quaility management system in place that demonstrates consistent conformity to guidelines.  I recently read that there are over 2300 safety and quality checks performed per batch of formula.

The FDA published regulations in 1971 regarding minimal concentrations of vitamins and minerals necessary for each infant formula.  An amendment in 1980 called the Infant Formula Act allowed the FDA to establish quality control procedures for the manufacturing of formula, as well as regulate labelling.

As pediatricians, we strongly recommend breastfeeding as the best nutritional support for infants, but realize parents make choices regarding supplementing or switching to formula.   It is never a good idea to "water down" formula to make the can last longer; if cost is an issue, I definitely advise patients to switch to store brand formulas.

Store brand infant formulas and their designations:
WalMart - Parent's Choice
Toys R'Us - Babies R'Us
Target - Up and Up
Sams Club - Simply Right Baby Care
Kroger - Comforts for Baby
Walgreens - Walgreens
CVS Pharmacy - CVS Pharmacy
Rite Aid Pharmacy - Rite Aid Tugaboos

Store brand formulas and the brand name equivalents:
Premium formula = Enfamil Premium
Advantage formula = Similac Advance
Tender formula = Gerber Good Start Gentle
(has partially digested whey protein - to address fussiness/gas issues)
Gentle formula = Enfamil Gentlease
(has partially digested whey protein - to address fussiness/gas issues)
Sensitivity formula = Similac Sensitive
(has low lactose for babies with lactose intolerance)
Soy-based formula = Enfamil Prosobee or Similac Isomil
(soy protein instead of cow's milk protein)
Added rice formula = Enfamil AR
(added rice starch designed to aid babies with reflux)
Organic formula = Similac Advance Organic
(certified organic by USDA)
Toddler formula = Similac Go and Grow, Enfagrow Premium Toddler
Newborn formula = Enfamil Premium Newborn

Treating Iron Deficiency Anemia

Iron deficiency is still on the list as a cause of anemia in children, though we see it somewhat less often than we did 10-20 years ago.   Typically children with iron deficiency anemia present at 9 months - 2 years of age, the toddler transition period in which some of them drink large amounts of milk (which interferes with iron absorption) or do not adjust well to a solid/table food diet that has adequate amounts of iron.  A second "peak" age for iron deficiency is noted in teenagers, particulary in teenage girls, whose menstrual cycles can be a source of blood loss coupled with a poor, low iron diet.   I recently  read an article about iron deficiency in teens that touted the effectiveness of iron-fortified breakfast cereals as a source of iron.  Many teenagers may be willing to eat breakfast cereal several times a day, as opposed to taking oral iron tablets.  I have included a list of cereals below.

Oral iron medication can be pretty distasteful, so much of our education in the office is spent stressing foods that either help iron absorption or foods that contain large amounts of iron.  For some "picky" children,  this can sometimes be difficult.  Teenagers may be able to tolerate oral iron tablets, but can sometimes forget to take the medication.  In this group of patients, discussing iron-rich foods is again an important aspect of treatment.
Iron deficiency may be suspected if a child's hemoglobin or hematocrit are low, and a dietary history is suggestive.  If a complete blood count (CBC) is done, the Mean Corpuscular Volume (MCV) will typically be low in iron deficiency, and the Mean Cell Hemoglobin Concentration (MCHC) may also be low.  The Red Cell Distribution Width (RDW), which measures the span of red cell size in circulation will typically be high in iron deficiency.  If further labwork is done to confirm iron deficiency, your provider will typically measure an iron level, as well as transferrin, ferritin and iron percent saturation.

In iron deficiency, oral iron therapy will stimulate new red cell formation in 5-7 days.  Some providers will check a reticulocyte count (which measure the amount of new red blood cells) to confirm the benefit of therapy.  Once someone has been on iron therapy for a month, a repeat blood count can be done (or the more complete CBC - as mentioned above).  Iron therapy is usually continued for a minimum of 3 months.

FOOD SOURCES OF IRON
GOOD - raisins, dried fruits, potatoes with skin, tomato juice
BETTER - oatmeal and breakfast cereals, beans, nuts and nut butters, bread, pasta, cooked spinach, eggs
BEST - beef, fish and shellfish, pork, chicken and turkey

FOODS THAT AID IN IRON ABSORPTION
Foods with Vitamin C can increase the absorption of iron; eat these foods along with iron-rich foods to increase your body's ability to absorb iron
bell peppers, mango, tangerine, oranges and orange juice, papaya, grapefruit, strawberries, broccoli, melon, green leafy vegetables, tomatoes, cabbage

FOODS THAT INTERFERE WITH IRON ABSORPTION
Some foods block iron absorption, and should be eaten at seperate times from iron supplements or iron-rich foods.
milk, cheese, yogurt, coffee, tea, chocolate, blueberries, grapes, popcorn, tofu

IRON-RICH BREAKFAST CEREALS
The list of the best cereals based on milligrams of iron present per serving:
General Mills - Total and Total corn flakes, Total raisin bran and cranberry crunch, all Chex (corn, rice, honey nut, multi-bran, frosted), Cheerios yogurt burst or multigrain, Kix
Kellogg's - Crispix, Frosted Mini-wheats, All Bran complete wheat flakes, Product 19, Complete oat bran flakes, Smart Start, Rice Krispies, Shredded Wheat
Malt-O-Meal Puffed Wheat, Puffed Rice, Frosted Mini Spooners, Crispy Rice, Honey Graham Squares, Toasty O's
Kashi Mighty Bites, honey crunch

In my practice, I routinely give patients with iron deficiency a handout with the above foods and cereals listed.   In most cases, changing one's diet can treat iron deficiency effectively without the need for iron medication.