Why Pediasure May Make Your Child’s Growth Impairment Worse

Why Pediasure May Make Your Child’s Growth Impairment Worse

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Recently a parent was surprised to hear me mention that food allergies and sensitivities can create growth impairments in infants and children. Like many parents, this one had been told to turn to products like Pediasure to help his child gain and grow. But it wasn’t working.

I see this a lot in my practice. Undiagnosed and poorly managed food allergy, sensitivity, or food protein induced enterocolitis syndrome (FPIES) are probably the most common problems I encounter. But it still surprised me when a blog I posted on alternatives to Pediasure went viral. I realized that this means that Pediasure is possibly the top go-to for pediatricians nationwide, when they see an underweight child. And that is downright unfortunate.

As I explained in that Pediasure blog, if a child has a reaction to the proteins in Pediasure (milk and soy), then this product is going to do more harm than good. Besides weakening growth pattern, these reactions can cause diarrhea or constipation, rhinitis, dermatitis, or brochospasm. But, it’s routine for pediatricians to hand out Pediasure samples or coupons anyway, without checking if a protein intolerance, allergy, or other reaction is part of the problem.

If your child is experiencing symptoms described on this page, and especially a growth lag, it’s time for some lab work or professional guidance on an elimination trial. Inconvenient? Sure. But you might prevent months or even years of frustration as your child struggles with a withering growth or feeding pattern, frequent malaise, cognitive or developmental delays from low nutrition, or picky eating. This I have seen, all too often – and it’s all preventable.

Coincidentally, not long ago, I was contacted by Abbott Nutrition, the makers of Pediasure. They wondered if I would like to create webinars for them about autism and nutrition. I would have loved to, but I gently explained on the conference call that I rarely recommend dairy or soy protein sources for kids with autism, because our lab work-up usually shows these proteins to be reactive in these cases. So, no, I could not create webinars for fellow RDs or MDs that would keep this long-known piece of the autism puzzle out of the powerpoint.

That was sticky. So I threw the Abbott folks an olive branch by explaining that these kids can at times thrive with an amino acid based formula like Elecare, which Abbott also makes – and this is true. However, apparently, the Abbott people had somehow remained in the dark about all this for the last fifteen years. Needless to say, they later decided to “move the project in a different direction” – which I took to mean, find a dietitian who would help them sell Pediasure to families of kids with autism.

Hopefully that’s not you. There is so much more you can do, and do better. Solutions? If your child is already stuck in a growth or developmental rut, and showing diffuse signs like frequent colds or illnesses, fatigue, shiners at eyes, crabby or anxious affect, underweight, or funky stools, then it’s time to look for why this is happening. So far, in my fifteen years in practice, I’ve never met a kid who didn’t have a “why”. And we can usually find a solution.

Start with some thorough testing for reactions to foods. Here’s the rub: There are many kinds of reactions that the immune system or gut can contrive. If you’ve had basic allergy testing that was negative for your child, there’s probably more to the story. Here’s a strategy:

– If your child has IgE allergy symptoms like hives/vomiting/tingling of still unknown origin, complete a comprehensive IgE food antibody panel – go beyond the usual few foods tested (milk, wheat, corn, soy, peanut, egg). Great Plains Lab (GPL) and Genova Diagnostics (GDX) offer full panels, and I will request these for my patients where indicated.

– If your child does not have IgE allergy symptoms or positive results, but does have any of these: Bloating, reflux, mixed irritable stools, constipated stools, loose stools, anxiety, intermittent skin rashes, picky weak appetite, or trouble sleeping, then consider an ELISA IgG food antibody panel. GPL and GDX offer test panels to screen over 90 foods with one small blood sample. These reactions can appear often and independently of the IgE reactions, so testing both can be important.

– If you’ve done all this testing and still have no answers, consider a white blood cell antigen test with ALCAT labs. This is another option I offer in my practice. It examines yet another way that the immune system may react to a food protein, separate from antibody production. Looking at how white blood cells respond to food proteins is fraught with challenge because there can be false positives, but this test can uncover missing pieces in some cases.

– Even more detail can be scrutinized with IgG reactions to other compounds derived from food proteins in our bodies, and for cross sensitivity to our own tissue (autoimmune reactions exacerbated by food proteins) . Cyrex Labs offers these panels.

– If your child has firm or constipated stools, an extremely rigid appetite for wheat or dairy foods, and horrible behavior if he doesn’t get those foods, consider a gluten casein urine peptide test from GPL. This reaction to wheat and dairy protein is not immune-mediated. Instead, it assesses how completely the gut digests these proteins, and whether the gut wall is overly permissive in taking up poorly digested protein fragments (peptides) of gluten and casein. Not an allergy, but a reaction that can make your child miserable never the less. Peptide chains from these proteins mimic endorphins in the brain. This means they are addicting, and will not only create fierce rigidity in eating patterns, but will exert an opiate like effect on your child’s brain as well. Children with poor verbal or social skills, who have aphasia (no speech), or who have very delayed speech may be under the influence of these dietary opiates. Other features of dietary opiates are high pain tolerance, happy affect except when hungry (Jekyll/Hyde) or uncontrollable tantrums. Toddlers and young kids with an active opiate effect also tend to wake between midnight and three AM, when they may laugh, babble, want to play, or make noise, though may not be unhappy or crying for parents.

– If you already know that gluten is a problem, but aren’t sure what other grains are safe, several labs offer an array of tests to review this very question.

– If you’re still wondering if gluten is the problem, visit my blog on gluten free diets to learn about that testing.

There is no shortage of options for lab testing on food reactions. The trick is in picking the right ones based on your child’s history and presentation, and this is precisely what I do for my patients. Many of these tests are not in your pediatrician’s repertoire, or even your pediatric allergist’s repertoire (if they were, they would have offered them already). Once we have some results in hand, we interpret them in the context of your child, and can create a plan for what to eat.

Transitioning to new foods for a youngster isn’t as hard on them as it is on mom and dad. It means parents have to learn new shopping, cooking, and kitchen routines, and this can be disruptive at first. Balancing this with siblings is a challenge too. But for many families who have watched a child wilt into growth regression, weakness, developmental delays, or frequent infections, it’s worth it.

If Pediasure helped your child, fabulous. If it hasn’t worked in your family’s case, rest assured – there are many options, many answers. If you’d like help with your child’s feeding and growth, schedule an appointment – I look forward to hearing from you!

Zucchini Overload? Delicious Way To Use That Bumper Crop

Zucchini Overload? Delicious Way To Use That Bumper Crop

Late August… and hopefully, your garden is producing all that you imagined it would. Great! Unless you notice neighbors and friends avoiding you so you don’t unload those enormous and not-so-tasty vegetables… Like zucchinis that would have tasted better if they were picked a week or two ago. Big giant zucchinis are fun to marvel at but not so good to eat as younger more tender ones.

No worries. Here’s one way to handle giant zucchini: Make fritters. These are delicious, fast, savory, and a good side with many dishes. We enjoyed ours with a homemade chicken vegetable soup for a satisfying dinner. Try them with a white fish if you’re lucky enough to have access to something fresh and local, a light and simple chicken dish, or even for breakfast (no maple syrup needed). A food processor makes this much easier and faster. This recipe makes enough to serve four as a side dish.

Sure, you can bake zucchini bread, chocolate zucchini cake, and all sorts of zucchini sweets.. but this is easy and it keeps you out of too-much-sugar territory.

Zucchini Fritters

6 cups shredded zucchini

1 TBSP minced scallion (optional)

3 teaspoons sea salt

2 eggs

1/2 cup gluten free flour of choice (try half coconut flour + half almond flour, or half almond flour + half Hagman Blend)

1/4 teaspoon cayenne pepper

black pepper

1 TBSP ghee + 1 TBSP coconut oil

Overgrown zucchini work well. Slice in half lengthwise and use an ice cream scoop or melon scoop to remove seeds. Trim off ends, stems, or blemishes. Cut into chunks that can fit into a food processor, using the shredder blade. You can also use a box grater but this will take a good bit longer. Grate/shred the zucchini and set in a large bowl. Add the salt and mix thoroughly. Cover the bowl with a kitchen towel and set aside for ten minutes.

Whisk the eggs, then add the flour and whisk together until smooth with the cayenne. Set aside.

Use a strainer or cheesecloth to press the water out of the zucchini after ten minutes have passed. Return to bowl. Add the egg and flour mixture, and stir in the minced scallion if you are including it. Mix thoroughly.

Heat skillet to medium high and add the ghee and coconut oil. Drop about 1/4 cup of fritter batter onto the skillet, at about 1/2 inch thick. Brown on both sides, serve warm.


On The Lamb: Great Kabobs and Burgers

On The Lamb: Great Kabobs and Burgers

Lamb is a delicious meat that is considered especially nourishing for kidneys in traditional Chinese medicine, which regards lamb as the most “warming” of meats. It can contain as much as 50% of the omega 3 fatty acids found in fish, depending on whether it is grass fed and organic. Besides healthy fats, it is a great source of protein, vitamin B12, zinc, selenium, and niacin.

Don’t be daunted by its different flavor. Lamb burgers and lamb kabobs are favorites in my house. Adding flavors you don’t usually use for beef or chicken is the secret. Lamb is easy to cook!

Where to buy lamb? We love supporting our local organic, clean and green growers, and Colorado has several choices. We’ve bought ours at the Boulder Farmer’s Market for same price found in our local supermarket that sells organic meats (we haven’t yet found organic lamb in Boulder’s big chain supermarkets). We also love that the grower we buy from is located in a region of the state that has not succumbed to fracking activity. Fracking contaminates air and water with known carcinogens, and has been associated with birth defects and low birth weight for infants living within two miles of drill sites. Of course, all our ingredients are organic where possible.


Lamb Kabobs • Serves 6-8

2-3 lbs fresh lamb shoulder, trimmed of fat and sinew and cut into ~1-2” cubes


1/3 cup olive oil

1/3 cup white wine

1 TBSP minced fresh thyme leaves without stems or 1 teaspoon powdered dried thyme

1 TBSP chopped fresh or dried rosemary without stems

3 cloves garlic, minced

1 whole lemon, washed and cut into quarters

½ tsp Himalayan salt

¼ tsp fresh ground black pepper

• Blend all marinade ingredients in a powerful blender until smooth. Pour into a deep glass or ceramic bowl, cover with plastic wrap and set aside.

• Trim fat and sinew off lamb and prepare into 1-2” cubes. If lamb is frozen, thaw enough to easily trim.

• Place lamb in bowl of marinade for at least three hours. Do not marinate for more than 18-24 hours, as the meat will begin to break down.

• After marinating, discard the marinade; use metal skewers (these heat through the meat better), and place 5-6 cubes of lamb per skewer.

• When ready to cook, turn gas grill to medium high heat. Charcoal grill should be medium heat. Place skewers on grill.

• Once on grill turn gas heat down to medium. Allow four minutes per side. Turn skewers 3-4 times so all sides are grilled.

• Use a meat thermometer to check for internal temperature of 140 degrees. Once there, remove from grill, and “rest” the lamb skewers in a warm place, covered with foil. They will continue to cook a bit to 145 degrees, which is medium rare. We use our oven on “warm” setting, about 150 degrees. Do not bake the kabobs in a warmer oven.

Serve with vegetable kabobs made of multi colored bell peppers, onion quarters or chunks, and mushrooms. We skewer and cook these separately so we can pay attention to cooking the lamb correctly; others combine lamb and vegetables on same skewer.

To make vegetable skewers, chop vegetable pieces into bite size chunks and slide onto metal or bamboo skewers. Brush with olive oil or melted ghee, sprinkle with fresh or dried oregano, and grill to preferred doneness (about 8 minutes for us).

Serve all with quinoa cooked in organic chicken broth and finished with capers stirred in.

Lamb kabobs are a healthful and delicious meal when your grill is at the ready. But what about those burgers? Which ever you are cooking, you can broil indoors. Set oven to 400 and cook for 6 minutes then rotate your kabobs, two or three times, until done (or until your meat thermometer reads 145 degrees). Let the kabobs rest a minute or two before serving.

For burgers, buy organic ground lamb and include a few tasty additions. There are countless recipes on the web for lamb burgers, with variations that include mint or proscuitto and more exotic items, but my favorite is this simple one from Food Network. I skip the yogurt sauce since we are a mostly dairy-free household. I make the burgers about 4-5 ounces each instead of “mini”, and serve with extra Dijon mustard, big juicy local tomatoes, onion slices, avocado, lettuce, and a slice of raw goat cheddar if available. Always a hit.