COVID-19 is our moment to rethink infection, and to rethink health. It’s a big moment.
By now, you know that we’ve seen corona viruses before: Middle Eastern Respiratory Syndrome (MERS) in 2012. Sudden Acute Respiratory Syndrome (SARS) in 2002. In fact, corona viruses were first discovered in the 1960s and have long been understood to cause a “substantial” portion of upper respiratory infections in children (that is, common colds). Despite decades of scientific effort, we haven’t emerged from any of this with sure fire preventives, drug treatments, or vaccines.
COVID-19 has been wreaking havoc and defying experts worldwide. COVID-19 behaves so differently in different persons that Atlantic Monthly has called it “a disease of the immune system”. Robert Murphy MD, a professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University, was quoted in that piece to say this: “’There’s a big difference in how people handle this virus…It’s very unusual. None of this variability really fits with any other diseases we’re used to dealing with’…When doctors see this sort of variation in disease severity, ‘that’s not the virus; that’s the host.’”
Essentially, COVID-19 kills people best when their immune systems over-respond with uncontrolled cascades of inflammation. It appears to exploit whatever your weak link is, and destroy from there, whether it’s lung, kidney, gut, heart, or brain tissue. Apparently, this virus isn’t picky, but it sure is wiley. Not everybody’s immune system is doing this. As more are screened for exposure status, we are seeing death rate drop, to perhaps as low as half a percent. #COVID19 is looking like an infection that serves up a catastrophic clinical course, but only for a subset of vulnerable people.
One option is to take the cue from Dr Murphy quoted above. It’s time to figure out why that half percent gets hit so hard.Maybe the solution is not about the virus. Maybe it is about our immune systems, which vary widely in their status, functionality, and readiness, and in our own risk factors, which are virtually exponential in complexity when we consider genetics, nutrition, health habits, toxic exposures, stress, drug use (recreational and prescription), and more. All of these impact each other, creating potential synergies in any direction, when you toss COVID-19 into the mix.
Right now, our health care system is a reductionist one that silos health problems into discreet specialties. It doesn’t pay much attention to nutrition or food, or toxic exposures, in routine care. COVID-19 has laid bare what a catastrophic fail this is, as it devastates a select few of us in so gruesome and terrifying a fashion. By “few”, I mean this: Tens upon tens of thousands of deaths is a lot. Relative to the total population, it’s a very little. A long list of other conditions, infections, and diseases affect many more of us. But we don’t shutter the globe in response. We figure it out.
We are likely to get it too, as COVID-19 becomes endemic. This appears to be well underway, as reports roll in of deaths from COVID-19 identified as having occurred in the US in early February. New York just announced a finding of positive antibodies in 14% of a sample of people tested in that state, suggesting that the death rate is closer to one half percent. Why are some of us getting so sick, some of us dying swiftly, some of us feel hit with a bad cold, or some just a minor sniffle, some GI symptoms – or even more peculiar, a fatal stroke? There are more viruses than there are stars in the universe; they are here to stay and part of life on earth. Can we figure out how to live with them, rather than die by them?
Developing a COVID-19 vaccine is fraught with challenges – not the least of which is that corona virus vaccine efforts have posed “unique safety challenges” in that it may trigger responses that vary as wildly as the infection itself. It may kill or injure people, it may cause infection in some, it may give some people immunity, and it may give others no immunity at all while weakening their response when re-exposed. Recently, the World Health Organization (WHO) suggested that immunity to this virus isn’t a protective certainty after infection. If that holds true, then a vaccine may be doomed. The entire premise of vaccination is that antibodies triggered by the injection will protect you. If naturally acquired antibodies don’t work, how could triggering you to make your own from an injected version of the virus work?
Without usual process for safety and efficacy, such as has been proposed in the scramble to have a vaccine, these are ominous frustrations. Peter Hotez MD, PhD is a researcher you may have heard about who has tried to make a corona virus vaccine in the past. So far, no good. In Congressional testimony, he describes unexpected reactions from an experimental vaccine and mentions that two children died (at minute 25:40 in this transcript) in a human trial of his most recent attempt. As a vaccine scientist who invents vaccines, he’d like more than anyone to see this work. In a recent podcast, he eloquently thumbnails what we’re up against. He points out the footdragging the US had on testing and quarantine, which we now know let COVID-19 circulate for a long time. He describes what we’ve all heard many times over too, about who is most at risk, with an odd twist not often mentioned. We know that kids and adolescents are less affected. The elderly are at high risk. Anyone who is immunosuppressed or with underlying conditions is in trouble too. And, this obvious, but rarely stated, twist: Health care workers contract a severe version of the virus, despite their age – young or old. Why? Why don’t they get sick like other exposed young people, and recover?
An opportunity lies there to dig for clues. Health care workers are the most highly vaccinated among us; they receive boosters at least annually for influenza (some workplaces require these biannually), and boosters of other vaccinations more often than most of us likely do. Shouldn’t this somehow be protective? Or is this part of the problem? Detecting a phenomenon called “vaccine interference”, a study of military personnel showed that those with prior flu vaccination had higher risk of contracting corona virus than the unvaccinated: “Vaccine derived virus interference was significantly associated with corona virus and human metapneumovirus”. In other words, in this study, having had a flu shot meant you were more likely to get sick with corona virus.
You might think Dr Hotez would be the loudest on the podium touting a shot as the single silver bullet that can fell this demon. He tried to make one just for this moment, but failed. He knows this can’t happen fast, and that we need action right now. One of the immediate solutions that he and colleagues are thinking of is “convalescent plasma coronavirus therapy.” That is, give immunoglobulin (antibodies to COVID-19) from a recovered person’s purified blood (plasma) and infuse or inject it into a sick person who is not recovering. This worked for SARS, Ebola, and MERS. Development of this biological product for COVID-19 is already underway, despite the WHO nay-saying on this strategy.
Immunoglobulin (Ig) therapy has been around since the 1950s, but not specifically for COVID-19 (no has had antibodies to it, until now). Ig is tried and true, effective, but costly; a pool of many hundreds of recovered persons is needed to extract enough immunoglobulin to treat just one person. It currently costs thousands of dollars per dose, even tens of thousands of dollars per dose, to receive Ig therapy for other conditions, so insurers are loathe to cover it. But Dr Hotez would like to see a low cost version of this made available.
Even if “low cost” means, say, $800 per dose, it sounds great – if you can manage to jump through the health insurance hoops and hurdles that will surely be raised to stop you. COVID-19 has laid bare many ills in the US in 2020, with one of the most glaring being that our for-profit health insurance and health “care” industries are a fail for consumers. There is no covered, federally coordinated access to screening to show who is infected. Millions have spotty access to health care, if they have any at all. It’s more profitable for insurers and care providers to patent and sell a vaccine, than it is to sell immunoglobulin therapy, screen everyone for antibodies, or screen everyone – before exposure – for a laundry list of risk factors like inflammatory markers or nutrients that our immune system draws on to fight infection (ferritin, ESR, homocysteine, serum iron, serum vitamin A, vitamin D, and zinc to name a few). Whether Ig works well or better than other tools isn’t relevant in our care model; whether it’s profitable is.
In Dr Hortez’ podcast mentioned above, he goes deeper into why rushing a COVID-19 vaccine is a bad idea. Among the obstacles is “immune enhancement”, a known phenomenon already seen in animal trials with corona virus vaccines (and others like AIDS) in the past. Industry scientists have long found this phenomenon to be a stumbling block that “proved to be counterproductive” in that it “renders vaccinated subjects more susceptible to infection rather than protects them.” To quote the podcast, “Vaccine trials have begun in Washington which is a positive, but we will also see immune enhancement in [the] volunteer population”. Make no mistake: Researchers know from past experience that COVID-19 vaccine trial test subjects are going to either step on a cytokine cascade landmine (potentially deadly), or suffer “immune enhancement” (potentially deadly if re-exposed), or may be just fine. Here’s how one reader put it, in the comments following Dr Hortez’ podcast:
March 17, 2020 at 4:03 am I think you heard Dr. Hotez correctly: vaccines for highly pathogenic viruses are problematic because they cause “enhanced immunity”. This is a heavy euphemism for the patient’s uncontrolled inflammatory cascade, called a cytokine storm, which causes illness and death in the ebola, MERS and SARS patient. So in a disease whose mechanism of fatality is the host’s immune over-reaction (cytokine storm manifesting as ARDS etc.), vaccines–whose adjuvants aim to “jolt” the immune system into action–can make the reaction even worse. This is one reason why a SARS-1 vaccine development was halted; although the mice survived the vaccine fine, they were dying at high rates after they were re-introduced to the virus after innoculation. For this reason, therapeutics may be the better solution to this SARS-2 virus than a vaccine.
What to do? Hopeful puzzle pieces are emerging. Persons with healthy immune systems show promise for recovering, provided that their immune systems do what they’re built to do, without going haywire.
Immune systems are complex with lots of opportunity for “haywire” to happen. The good news is, we can minimize the haywire and build functional, meet-your-COVID-exposure-safely immune performance with nutrients, food, supports for inflammation and detoxification, and with better monitoring and management of our own risk factors. So far, policy and practice in the industrialized world around infectious disease mostly disregards all that. On a policy and practice level, we haven’t looked much into how to enhance our own immune response so that it is balanced and effective, or why some immune systems do it right while others get it wrong. We’ve focused on drugs to control symptoms during infection, on vaccines, and on drugs to kill infection. But COVID-19 is shaking these foundations to the core. These 20th century strategies are failing us with this one. This is grim, but it means there is opportunity to pivot and integrate some cool new stuff. Practitioners in the functional medicine realm have been doing this all along. Some pearls have already emerged, more are sure to follow.
One shockingly simple finding may be right under our noses: Severe COVID19 patients can have dramatically high levels of ferritin, even exceeding a value of 1000 ng/mL. This is a very high level that reflects intense inflammatory process underway. Ferritin is a means to make iron safe in the blood. It scoops up free iron when iron, a powerful oxidative stress element when free in the blood, gets too high. This high level of iron will set off inflammatory cascades in itself and slowly poison patients. It’s possible COVID19 is doing this by knocking iron off of the hemoglobin on red blood cells, so it to floats free in the bloodstream. No iron on hemoglobin means no oxygen can attach to your red blood cells, and you will essentially suffocate while the inflammatory cascade is encouraged from too much iron.
A simple way to oppose iron is to supplement zinc. COVID19 patients who report a sudden loss of taste and smell are reporting one of the classic textbook signs of zinc deficiency. They may be rapidly depleting zinc to meet demands set off by infection. This may be just one of the trip-wires that sends some patients into a rapid decline, while others muddle through. It’s not exotic, but it’s worth exploring. It would be a lost opportunity if it were true but instead we took a detour into how COVID19 might affect olfactory nerves.
COVID-19 is ruthless and devastating for the vulnerable among us, and incidental for most of us. If we follow our own hallowed tenets of epidemiology and herd immunity, according to Scott Atlas MD, a health policy expert at Stanford University, the most protective-for-all thing to do is to “stop the panic and end the total isolation”. That is, go back to work, come out of hiding, and build population immunity naturally, while identifying and supporting those who are at risk. We have tools at hand right now, and they may be deceptively simple. From tapping older less profitable drugs (less profitable because they are off patent and available generically) to engaging essential tenets of the nutrition / immune interface, we have a lot to work with already.
About The Author: Judy Converse MPH RD LDN is a licensed registered dietitian nutritionist. She holds a master’s degree in public health with nutrition major from University of Hawai’i / Manoa and a bachelor of science degree in human nutrition from University of Vermont. She has lectured widely and authored several books on pediatric nutrition and specializes in nutrition intervention, monitoring, and support for children in her private practice. She has worked with health insurers on nutrition service delivery and with industry partners on medical foods.
I’ve been in pediatric nutrition practice for some 20 years, but these health and nutrition myths just won’t quit. They can keep kids sick when they could be enjoying better health. Here are 7 myths I encounter week after week. They’re powerful enough to steer your kids away from health and into being more sick, more often. Change your mind about these myths, and your kids may enjoy more health, more often.
Myth #1 – It’s normal for toddlers to be sick all the time …Um, not quite. Common? Yes. Normal? No. A toddler who rides a roller coaster of colds, infections, stuffy noses, coughs, diarrhea, or malaise every month, for more than 5 or 6 times a winter, with or without fevers, or who needs antibiotics over and over before age 2 or 3, gives me pause. So does a child who never gets a fever, but isn’t thriving either, and is often fatigued. Kids should not be sick more often than they are well. Yes, little tykes are vulnerable; their immune systems are developing, and if they were not breastfed, they haven’t been given that powerful foundation from mom’s immune system to protect them.
A cold or virus with a vigorous response – like a fever to 103 or so – that drops your child for a few days is a healthy and necessary challenge for the immune system to develop. But toddlers should bounce back, and resume a hearty eating pattern to restore depleted nutrients burned up during illness.
Nutrition and food make it possible for the immune system to work. When we’re sick, we make big withdrawals out of our nutrition bank accounts. For growing toddlers, this is especially costly – like borrowing money on a 25% interest rate! They need a lot of strong nutrition for growing, and for fighting illness, when they’re sick. We store nutrients for these occasions – especially iron, zinc, vitamin A, and vitamin D. We also use our own protein – which we store in functional structures like our organs, bones, muscles and flesh – to help fight infections. So if a child has a weak growth pattern to begin with, or is even just a little bit underweight, there won’t be much to work with if illness keeps knocking him down. A downward spiral of malnutrition and infection can ensue, and this is dangerous for tots.
PSA: Here we go with everyone’s favorite topic… The shot schedule. My 2p? It’s overloaded, fails often, and creates opportunity for mutation into more virulent strains of the viral and bacterial material in the shots. Vaccines can also cause the infections they are meant to prevent, such as in this case. The medical community understands overuse of antibiotics and has made big efforts to cut this back. Not so with vaccines. There is a mania that more are better. Believe me, my public health master’s degree gave me full indoctrination into immunization theory and practice. But these practices are not working, and after 20 years in clinical practice, I’ve had an about face. Despite having many more vaccinations than ever, kids are more sick and disabled than ever in US history, and not a single “vaccine preventable” disease has been eradicated. It is not because your neighbor opted out. It is because natural, long lasting, robust immunity from actual infection has all but vanished, and because vaccines can spread infection.
Vaccinated people can shed and spread infection from recent shots. This is called “secondary shedding”. Evidence of this is documented for flu vaccines, chickenpox, measles, polio, and many others. If you’re seeing your kids get sick when school starts…. it may be because everyone just got vaccinated and is shedding infectious material. Check out this sign at my neighbor’s condo association pool, barring anyone with recent vaccinations:
Dilemma: Your pediatrician’s bread and butter is giving vaccinations, and prescribing drugs. That’s about it. Since their degree required little to no deep training in nutrition, they may not recognize nutrition problems that drive frequent infections. If your child is sick more often than well, if colds and infections just won’t quit, what to do?
- Have your child’s levels of quantitative immunoglobulins checked. Low immunoglobulin means low defenses. Good nutrition and food build this back up eventually, but other special measures may be needed.
- Improve your child’s growth pattern. Are they underweight? Are you sure? Even being modestly underweight may drop immune response and defenses.
- The immune system needs iron. When it’s depleted, infection fighting is harder.Check iron status with a full iron study, not just with hemoglobin (Hgb) and hematocrit (Hct). Hgb and Hct are crude measures that capture only profound anemia. Ask your doctor to do a full iron study to see if your child is pre-anemic. An iron study includes ferritin, serum iron, transferrin, and saturation. Don’t start iron supplements without guidance – iron can be poisonous at the wrong dose.
- Get your child’s vitamin D level checked. It should be well above 30. At our office at Flatiron Functional Medicine, we look for levels in the 50-80 range for good immune protection.
- Get your child’s vitamin A level checked (also called serum retinol). Vitamin A is crucial for immune function, and upper respiratory infections, measles or chickenpox in particular. Unless your child likes to eat liver, cod liver oil, lots of fortified dairy food or grass fed butter, and/or orange and green vegetables, a marginal or even deficient vitamin A level may ensue. Marginal or deficient vitamin A places your child at higher risk for complications from measles or measles vaccine.
- Don’t vaccinate a sick child.
- Breastfeed as long as you can.
- Camel milk is a good source of potent immunoglobulin. Consider using a few ounces daily. If that’s just too weird, consider using a bovine serum derived oral supplemental immunglobulin like this one, or colostrum, if your child tolerates milk protein.
- Keep your child home after vaccinations if they don’t feel well. Avoid recently vaccinated peers just as you would avoid a sick child.
- Balance your kids’ meals and snacks so they get about a third of all their food as fats or oils, about half as clean, non-processed, non-sugary carbs, and about 10% as high value protein. Vary the protein they eat, so it isn’t always the same source.
- Use as much organic food as you can afford. Pesticides in food burden the immune system further.
Myth #2 – Picky Eating Is A Willfull Behavior Choice ….Followed by “your kids need feeding clinic” (maybe they don’t) and “they’ll grow out of it” (I have many kids in my caseload in their teens who …didn’t). Nope nope nope.
Picky eating is a downstream effect of three things: Gut dysbiosis, mineral imbalances, and exogenous opiate peptide formation from wheat, dairy, soy and pea protein (like Ripple milk, or plant based protein powders). Watch this short video for a fast explanation.
What sets this up? Reflux medicine, C section delivery, antibiotics (for mastitis, at delivery, during pregnancy, for your child, or a long history of your own yeast infections and dysbiosis prior to pregnancy), early vaccinations… That’s where it begins. This parade of interventions and pharmaceuticals from birth insidiously but profoundly change the gut biome away from a healthy early profile and toward disruptive microbes like Candida, Rhodotorula, Klebsiella, Prevotella, too much Staph or Strep, or even Helicobacter pylori. Sometimes I will see a protozoan pop up on DNA screen stool studies too. These in turn usurp minerals out of the diet and make them harder to absorb too, due to subtle shifts in pH in the digestive tract that these microbes create. Ultimately, appetite can drop, the poor diet begets more poor diet, because weak zinc and iron status tend to trigger pickier eating. Next, this scenario also degrades digestion of proteins. When proteins like wheat, dairy, soy and pea are poorly digested, they become “dietary exorphins” or “food derived opioid peptides” that trigger effects on the nervous system.
Once this is in play, your kid is indeed addicted to that white diet (Goldfish crackers, yogurt, noodles, milk, milk, Pediasure, milk, more milk, cheese, pizza, mac and cheese, pasta, bread… and of course sweets). Other foods will be absolutely refused even if you let your child go hungry – because other foods don’t give that opiate-like kick. There is literally addiction chemistry here working against your child. Sure tells that this is happening to your child, besides the fierce picky eating, are hyperactivity, behavioral volatility, dilated pupils after meals, and/or delays in expressive language or socialization.
Breaking this pattern can be done. I’ve helped hundreds of families break it, and it has nothing to do with convincing your child to like something else, or sitting through agonizing feeding clinics where your child is pressed to place different foods to their lips against their will.
Full disclosure: The only thing that makes a nutrition intervention, and not a behavioral one, for this fail is when parents bemoan how hard it is. Yep, it’s hard. But it can be done through a methodical reboot of your child’s gut environment, with individualized strategies for supplements and new foods. Start with this e book if you want to break picky eating. Spoiler: Probiotics alone won’t fix this.
If your child has mechanical issues with swallowing and feeding, then of course they need feeding therapy. For other kids, unless the underlying nutrition and gut biome problems that cause picky eating are professionally assessed and corrected, feeding clinic may not be necessary or helpful.
Myth #3 – Kids Get Constipated Because They Choose To Hold Stool – Gaining potty skills is a process for sure, and some kids do get flummoxed around it to the point of trying hard to withhold stool. In 20 years, I have had one legit case of this. For all the hundreds of other kids, they were constipated because of (a) disrupted gut biome and (b) dietary exorphin formation.
Most of these kids had Candida or fungal microbes flourishing in their intestines. How did we find out? We did urine and stool studies to show it. These are not yeast infections that their pediatricians noticed – because the kids didn’t seem outwardly sick, didn’t have immune suppression, and didn’t even always have white flecks in stool, white or grey coated tongues, flat or concave nails, or ringworm rashes (all tell tale signs of fungal dysbiosis). What they did have were bloated bellies that wouldn’t quit, fierce cravings and picky eating for starchy processed food or sugar, behavior challenges, lots of Miralax in their histories, and, constipation. Some of them also had epic battles with bedwetting into their tween years, which turned out to be a Candidiasis of the urinary tract.
Clearing the dysbiosis does the trick. This takes thoughtful intervention with probiotics, antimicrobial herbs, or in some cases, prescription anti fungal drugs, as well as some upgrades in what these kids eat. I choose all this stuff based on each child’s history, labs, and presentation.
The other constipation trigger here is the opiate peptide business (See Myth #2). Casein digested into casomorphin, or gluten digested to gliadorphin, are both powerfully constipating – after all, they have opiate-like effects, and if you’ve ever needed pain killers for a surgery, you know the drill. In some cases, the constipation doesn’t quit til those proteins are 100% strictly removed for at least three months. Because soy and pea protein concentrates do the same thing, swapping out milk or wheat protein for pea or soy can fail. Ripple milk, Vegan Orgain, and any plant based protein powder may have pea protein concentrate or soy in it and will continue the constipated pattern in some cases. Digestive enzymes may help, but this isn’t as effective as removing the offending foods. If you use enzymes, buy one that has dipeptidyl peptidase IV in it (DPPIV) at a high concentration. After some gut repair and good nutrition replenishment, wheat and dairy may be fine once again, but don’t expect results from a reduced intake of these foods – they may have to entirely vanish to get your child pooping again.
Myth # 4 – If my pediatrician didn’t say so, it’s not real – The American Medical Association and the American Academy of Pediatrics don’t require rigor with respect to nutrition, for those getting MD degrees with specialty in pediatrics. Only about a third of doctors routinely discuss nutrition at clinic visits, and most report they don’t feel adequately trained in nutrition (they’re not).There are big knowledge gaps for pediatricians when it comes to nutrition. So when you go in with questions about foods, supplements, or special diets, you may come out empty handed at best, or chastised at worst. Don’t stop there, or assume there isn’t a solution, if your pediatrician can’t answer your questions or tells you there’s no evidence that a nutrition measure might matter.
Odds are, there are some very good data on whatever your question may be. Nutrition is a thoroughly pedigreed science that has been around for well over a century. There is so much possibility to engage information, research, and clinical experience from it that your pediatrician may not know about. Naturopathic doctors have more training in it, as does a pediatric nutritionist/dietitian (that’s me). Adding these resources to your care team can give your child better odds for better health.
Myth #5 – Cavities? #ThisIsFine – Cavities are no fun for anyone. Even kids who have good oral hygiene can end up with repeat visits to the dentist, for drilling, filling, capping, or extractions. It may seem entirely usual that everyone gets them. Well, not everyone does, and no, cavities are not a necessary childhood rite of passage.
Cavities are a canary-in-the-coal-mine scenario. They can be thought of as a flag for a disrupted oral microbiome, and/or a shortage of the strong nutrition that helps build teeth and enamel. A healthy mouth will harbor friendly microbes that do a good job of intervening on your behalf, and don’t let an overly-acidic environment erode enamel. And, a baby who gets to breast feed a long time will have a better shot at less crowding of the teeth, and thus less chance for cavities.
If your child has a frequent flyer punch card with your dentist, start with gut. Your child’s gut microbiome may need an overhaul away from Candida, yeast, Helicobacter pylori, or other disruptive species. These are fed by simple carbs, sugary food, and processed foods. If your child is picky, see Myth #2 above, and set a goal to bust that pattern. Ditch the reflux medicine if possible (if you’re using it), because this reduces absorption of both protein and minerals – two key components of teeth. If children have optimal nutrition during the time that teeth develop, they can avoid cavities. Vitamins A, D, K, and C along with healthy fats and protein, with wholesome vegetable sources of carbohydrates, can accomplish this task. For more on nutrition and cavities, visit the Weston-Price Foundation.
Myth #6 – Measles and chickenpox are deadly diseases. The short answer here is, yes, and, no.
So much has been said about this in recent years – most of it counterproductive – that it’s hard to consider bringing this up at all. As a senior practitioner who has been credentialed in my field for over 30 years, I can say the sea change in this has not been worthy. It has not translated into better health for children. The conversations now afloat, where anyone questioning vaccines is pilloried and branded insane, would have been shocking during my graduate studies the late 1980s. We were allowed, and encouraged, to question and investigate, as were our mentors and instructors. This was not forbidden in that day, as it is now. And yes, I studied immunization, epidemiology, and nutrition as a graduate student. Yes, I know of deaths from these diseases. Among my classmates were physicians and health professionals from Taiwan, Indonesia, Africa, Egypt, Pakistan, Vanuatu, Guam, and the like. For our graduate practicum rotations, we were flung to all corners of the globe, including underdeveloped locales where poverty and malnutrition were common. My classmates went on to positions in clinical practice as well as in policy, including for WHO, USAID, and the CDC.
Measles can kill a child in poor nutrition status. So can chickenpox, flu, or a common cold. Here is the lost part of the conversation: Nutrition, not vaccination, makes or breaks this for a child. For decades, the World Health Organization (WHO) has emphasized nutrition protocols for controlling infectious diseases, and for measles in particular (see Table 1 here for just one example and Table 2 here for another). Why? Because the immune system only works if it has nutrients to draw on to make immuglobulin, white blood cells, NK cells, a thymus gland, and so on. It can’t work from just a poke in the arm with a bunch of antigens and toxic adjuvants in it. It needs the body’s nutrients to respond. My classmates in public health knew this, witnessed this, and applied it. They did not go on caterwauling about vaccination, condemning people who deferred, or indulging emotional, religious-fervor, carte-blanche approval to using vaccines without limits. We understood that nutrition status was, and still is, the primary driver of whether or not a child may die from an infectious disease, have complications, or survive it handily. Whether you derive it from an injection or a natural infection, there is no immunity without nutrition to build it – period.
This is now so polarized a topic that effective discussion is impossible. Young parents have succumbed to relentless fear mongering and misinformation from the pharmaceutical industry (via its alliances at the AAP, FDA, and CDC) while actual science has fallen by the wayside. Millenial parents are in lock step out of fear of becoming social pariahs, willingly submitting their children without question, lest they be accused of being “unscientific”. At the same time this generation can grasp that the oil industry has lied about climate change since the 1960s, it is somehow lost on young parents that the pharmaceutical industry is, likewise, lying to the public about the safety (and efficacy) of its single most profitable sector. As long as pediatricians remain poorly informed on nutrition, they too will readily believe that an ever growing vaccination schedule is the only way to have immunity to anything. It isn’t.
For kids in strong nutrition status, measles and chickenpox are survivable and beneficial infections. Not only do these infections give effective immunity that lasts into adulthood, having had acute fever inducing infections in childhood like measles may lower risk of certain cancers later in life. Strong nutrition status means robust stores of iron, zinc, vitamin A, protein; access to clean whole foods and the appetite to eat them; and a body mass index somewhere between the 25th and 80th percentiles.
Nutrition and infection is a vast and complex topic. Our pediatric physician community is tragically not well versed in it. Hence, we have a nationwide army of pediatricians believing that only vaccines can prevent infection, while at the same time depending on giving them for their livelihoods. The truth is, not a single disease has been eradicated by vaccines so far, and like any other pharmaceutical product, it may not suit everyone. The strong arm tactics afoot to force vaccination are highly suspect – if a product truly works well, no one would object and no one would need to be forced to use it. In fact, vaccination itself may have loosed more virulent strains of several previously mostly benign infections, besides destroying the natural immunity that humans developed over eons of time.
If your child contracts either measles or chickenpox, consider these guidelines from Mayo Clinic. If your child has been growing well, eating well, and not picky prior to illness, odds are they will have the nutrition reserves to weather this successfully and will be gifted with robust immunity for many years. Vitamin A is crucial for fighting measles. Supplementing it during this illness may be necessary. If your doctor doesn’t know how to do this, see these WHO guidelines (Source – see page 45):
Myth #7 – Elimination diets will make my kid different and there’s nothing to eat anyway – When I became a mom, despite my degrees in nutrition, I knew virtually nothing of elimination diets or food allergy. I soon found myself on a steep learning curve. This was in the mid 1990s. No internet, no online support groups, no other moms in this boat. I was isolated, and cracking into my training, texts, and visiting medical libraries all over again, just like in graduate school. My son needed to eliminate gluten, soy, egg, dairy, and nuts back when nobody did this. Nothing could be bought ready made, including bread (we eventually found Kinnikinnick bakery in Canada, but that was the only one for years). I was often quite unwelcome at school events, family gatherings, or birthday parties because I would show up with “weird” food that my son could eat. I always made enough to share. I always asked hosts ahead of time if this was okay. Eventually, it was …fine.
We didn’t talk a lot about this in my house. We just made food. It wasn’t my son’s problem, it was mine. I was the adult, and it was my job to give him the freedom to eat and feel good, rather than eat and feel sick, like any other kid. If anyone had a problem with that, well, insert expletive here. He gets to be well and happy too. This was my mantra.
This made me learn a lot about food, cooking, and baking that I didn’t know. I learned how to make really good food and really fun and delicious treats for holidays and birthdays. It made me do a better job than I would have, of feeding my family.
If I could do it in the dark ages, you can do it now. There is so much awareness for food allergy now, not to mention thousands of food products out there ready to buy, mix, cook, bake, or just eat. Get to it. If you need help, let me know.
Halloween used to be pure fun, but now that so many kids have food allergies, it’s definitely complicated. Somewhere between 8-10% of US children have a life threatening food allergy. Among those, about 40% are allergic to more than one food. I’ll bet food allergies may be underreported – just in my own pediatric nutrition practice, I often meet kids who have never been screened by their pediatricians or referred to allergists – and lo and behold, we find food allergies.
Then there are also food sensitivities, and food intolerances. These can occur with or without allergy reactions (which is why your child may still feel or function poorly eating a certain food even if your allergist said it tested ok). Sensitivities involve layers of the immune system different from allergy reactions and tend to emerge more insidiously or slowly, with eczema, anxiety, stomachaches, picky weak appetite, or irritable stool pattern. Intolerances can be immune-mediated or purely digestive in nature, and can include those wacky behavior changes some of you see when your kids eat stuff heavy on dyes and sugar…. like, Skittles! Kids can have one or all of these problems at once – allergy, sensitivity, and intolerance – to some of the same foods, or entirely different foods.
There are ways around it. It’s not like it used to be when kids could go door to door (without parents even!) grabbing goodies indiscriminately, and bickering over who got what with siblings once home (always interesting at my house growing up with five kids). Here are tips to help your kids have fun on Halloween even if they have food allergy and dietary restrictions.
- Teal Pumpkin Project – if you haven’t heard about it yet, dive in! Look for the Teal Pumpkin for non-food treats and little toys.
- Trick or Treat Fairy who takes your child’s candy cache and leaves a coveted toy (or toys) in its place – like the Tooth Fairy, only better.
- Bake some allergen friendly treats to trade for candy. Cookies, bars, cupcakes, or even Halloween themed fat bombs – the choices are endless.
- Organic-ingredient candies are often allergen-friendly. They are pricier, but worth it if it means avoiding that ER co-pay or Epi-Pen drama, or just for your kids’ joy and peace of mind. Here are some examples (I have no affiliate relationships with these brands BTW – I just like these a lot)
- Alter Eco makes non GMO organic chocolates in several varieties. They aren’t certified gluten free, but have no gluten ingredients, and many have no nut ingredients. Some do have milk ingredients. Check out the Quinoa Crunch or Burnt Caramel, two of my favorites.
- The Natural Candy Store lets you choose candy by dietary restriction and by organic candy status.Give their grid a try, see what you get – it’s genius! Here’s what I got when I selected strict gluten free, strict peanut free, certified non GMO, no corn syrup, certified organic candy.
- Yum Earth makes certified GF, organic, nut free, non GMO and vegan (that means strictly dairy and egg free) candy ready for Halloween sharing.
Be Sure You Don’t Make This Halloween Food Allergy Fail! …Here’s a mistake I witness often working with well meaning parents: Feeling sorry for your child. Or, unwittingly, for yourself.
When a parent comes in after we’ve started nutrition care process and spends a lot of time explaining why this can’t work because it is too hard to find or prepare substitute foods ….Hmmm. That’s not where we need our focus, and it is not what your child needs to hear from you. It’s also more about you than your child. You’re in charge of what is in your house to eat, and you do have a large measure of influence over what your child eats at school. Let’s strategize about how to do it, not about how hard it is. And truth is, it’s not so hard – once you decide it isn’t, commit to it, roll up your sleeves, and get started. It’s not too different from a weight loss project: Ultimately, you just get your butt in the gym and change up some eating habits you know aren’t helping, and you make it a lifestyle commitment.
Forget the drama about how they’re missing out. Talk about that in front of your kids, or worse – to your kids – and they will believe they are missing out and will feel bad about it. Talk up all the new choices there are to explore, and engage your kids in the discovery process, whether it’s making homemade treats, taste testing new store bought ones, or dreaming about the toy-trade options. Happy Halloween!
How do you get your kids a decent lunch at school? You’re over the top with beautiful Bentos, containers, and boxes for all the best snacks and sandwiches you can think of, you’ve tried every healthy power bar, fruit, carrot sticks, rolled up turkey, hummus… You’ve resorted to the junk: Cheddar Bunnies or Goldfish, pretzels, chips, sugary granola bars… and it comes back barely touched at the end of the school day, right? Or you’re buying school lunch, but have no idea what it is, whether your child eats it, or why they come home and melt into tantrums day after day (hunger, maybe?) Here’s five tips to help this go a little better.
1 – Let yourself off the hook – and your kid too. You’re not the problem. Neither is your child. The school is. Lunch is too short, too chaotic, and too impersonal. Incredibly, some children literally don’t get to eat lunch at all, as they spend too much time lining up to get it and finding a table. Here is one example of a school where children actually dumped untouched trays of food in the trash because it was time for recess by the time they’d gotten their lunches – they never got to eat at all. No amount of curriculum is worth this. You can stuff curriculum into kids’ faces all day if you like, but guess what? It won’t work. Because when children are hungry, attention and learning drop. Hmm maybe this is why we hear that US kids are falling behind compared to other countries?
By contrast, check out this story and video about how school lunch is served in France. Imagine how differently children learn to value food, community, self worth, and social interaction, when they get to eat this way. Oh well. We are probably not going to get there anytime soon in the US. But I share this to illustrate how absurd it is to expect children to function well in our version of a school lunch system. It does not engender health, good digestion, or appreciation for food, self, or how to contribute to a positive group experience. Our system is downright competitive, and anxiety provoking, as kids must worry about what they’ll get, when they’ll get it, if they can eat it, how fast, where to sit… and must do it in a cacophony that could make your ears bleed. So give in to the fact that how your child eats at school is something you can’t likely change, at least not this week. Make up for it with family meals at home as often as you can, whether it’s breakfast or evening meals. Having family meals together on a regular basis has been shown to boost kids’ vocabularies, grades, and intakes of nutrient-dense foods.. and it lowers high risk behaviors in teens like drug use and drinking.
2 – Let your child eat what is easy during the school day. Literally, anything is better than nothing. Pack high protein finger foods, starchy snacks (yes, you read that right), and comfy favorites. Don’t worry about the carrots and celery that come home. They’re not going to help much anyway during the busy school day. Your child needs high density food. Their brains use nearly half the total food energy they eat every day, just to be and learn (adult brains use about half that amount). Starchy snacks give fuel quickly and while we can argue all day about why they’re bad, they are better than nothing. Think of it this way: You’re flight was delayed and your stuck in an airport terminal at 4 AM with nothing open for food. You never had dinner the day before or breakfast this morning. But wait: You found some crackers in your purse. Eat them, for God’s sake! Yes, it’s junk, and, it will give you a little help til you get to your destination. It’s not what you’re going to eat every day, but you’re glad to have it in that moment. Likewise, don’t sweat it if your child is eating some low value starchy snacks during the school day sometimes. Avoid processed high sugar or corn syrup snacks – but a blondie brownie (gluten free if necessary), made with strong organic ingredients, coconut sugar or maple syrup instead of cane sugar, and some awesome ghee or coconut oil for a brain boosting fat isn’t at all that bad. If allowed at your kids’ school, throw in some crushed cashews or other safe nut. A dense homemade or store bought bar every day with clean ingredients isn’t all that bad.
Lunch at an Iowa school, 1939 (courtesy Library of Congress)
3 – Fast finger foods are an obvious help. Expand on the starchy goodies by including some protein and fat rich options, like olives, hard boiled eggs, jerky or meat sticks, or collagen bars like BulletProof, Dr Axe, BonkBreaker, Caveman, or Perfect Bars (some from this brand have peanut). Other bars may source the protein punch from dairy, using whey or casein; you’ll need to skip those for a dairy free child. You might also see soy, rice, hemp, or nuts as protein sources. Scrutinize ingredients to fit your child’s needs. Generally, grass fed collagen is a good protein source that is non-allergenic for most kids. Another great option: Fat bombs, bite size power packed snacks that are easy to make at home with a few ingredients, and are beginning to appear on store shelves in various forms. Here is just one site that offers a cache of 45 fat bomb recipes. Look around the web for more from sites like Paleo Hacks, Paleo Plan, or under names like Paleo Energy Balls. Those recipes use nut butters often; some schools have a zero nut policy while others only limit peanut or have a nut free table. Lastly – macadamia nuts, if allowed at your child’s school, have the highest fat and calorie content of any nut. Even a few nuts give high octane fuel that can make the day’s journey easier. Ten nuts yields about 200 calories. Throw in a few organic, stevia sweetened chocolate chips if you want to make it a treat that skips sugar.
4 – Make the liquids count. Instead of juice pouches or boxes, consider a midday meal replacement power shake that adds fat, protein or micronutrients. Options abound for ready to drink stuff you can pack in your child’s lunch. Orgain drinks are widely available (even at Costco) in both vegan and dairy protein source versions. The vegan version is gluten, dairy, and soy free. I also love Rebble Protein Elixirs. A little pricey, but they are dairy, gluten and soy free, with big protein boosts from pea, sunflower, pumpkin seed, or hemp. They are less sugary, more nutritious, and cleaner than stuff like Boost or Pediasure, which are high corn syrup and low nutrition value with only GMO fed cow casein and GMO soy as the protein sources.
Many kids with severe allergies need an even more specialized product. One example is Splash ready to drink elemental formula for children. Though many in the integrative nutrition communities love to hate this stuff, in certain cases, I have seen it be quite successful for children with feeding difficulties and multiple food allergy. Downside: High cost, but may be covered on insurance for kids with documented multiple food allergy.
You can of course also always make your own smoothie and send it to school in a single serving container, but keep in mind that this makes more work for you, and it may take more steps for your child to eat it than products that come with a straw or easy open cap.
5 – If all else fails and your child is simply not eating lunch, meet with your school principal and teacher to troubleshoot. Ask if you can observe a lunch period, volunteer during lunch, or work with an advocate to observe for you, so your child isn’t seeing you at school to watch lunch (they will most likely behave differently in your presence). Is your child last to get to the table, struggling to know where to sit, klutzy with the tray tasks, overwhelmed by noise, too excited to socialize to eat? Identify what is not working. Solutions might be quieter seating with a lunch bunch rather than in the cafeteria en masse, leaving two minutes sooner to get to cafeteria with a peer, or reliable seating at a regular spot. Further ideas are talking to your principal about aligning recess before instead of after lunch, expanding the lunch period by a few more minutes, or creating conduct rules at lunch for noise or behavior for the whole school. In my son’s elementary school, lunch included clear conduct rules that meant no one left the table until everyone had finished eating and had cleared their trays/lunch sacks and trash. This meant that at the end of the half hour (yes, they had 30 minutes), twelve little angels were usually seated quietly waiting for the signal for the whole table to go out and play. Rather than bench seating or loose chairs, the cafeteria had tables with single circles integral for each little behind, like this. These omitted crowding or jostling for space. Find power in numbers with other parents for these larger changes.
When I was a kid, we actually got bussed home in the middle of the day for lunch. My school did not have a cafeteria. We were picked up, brought home, I had lunch with my mom and siblings, and got back on the bus to go back to school. I had a full half hour to eat once home. I never felt rushed or worried about lunch. It’s hard to believe this is how it used to be in an American public school. Times have changed, budgets are squeezed, moms aren’t home to serve lunch. Maybe someday our school system will reboot how it does lunch time to something more conducive to learning, but until then, give your child these options to at least get through the day on more than fumes – they deserve it!
If you’re a parent facing a new autism diagnosis for a child in your family, your head might be spinning about now. Where do you start? Medication? Behavior therapy? Speech therapy? Occupational therapy? Different classroom? Social skills group? What to eat or nutrition is probably the last thing you want to think about… not to mention the fact that your newly diagnosed child is probably an epically picky eater. While you know they should eat better, they just…. don’t. Ok so… Feeding therapy?
Nutrition Must Come First With New Autism Diagnosis Because…. Nutrition must come first with a new autism diagnosis, because autism is a chronic condition with unique medical and nutrition features. Kids with autism have higher rates of ear infections, respiratory infections, food allergies, asthma, gastrointestinal problems, sleep disorders, seizures, and nutrient deficits. Nutrition deficits worsen all the problems in that list, and nutrition can help repair them too.
No matter what level of severity your child’s presentation is for autism, nutrition is an essential tool to tap. It can make other interventions go faster, and work better. Nutrition is so pivotal, so central to your child’s brain and development that it’s just stunning how current practice for children with autism has overlooked this. But you may not hear much about it from your care team, even if your team includes a gastroenterologist. Don’t be fooled into believing that it doesn’t matter or can’t change your child’s developmental progress.
Brains Are Only There Because Of Food… Your child’s brain happened because you ate while pregnant. Severe malnutrition while pregnant can make us spontaneously lose the baby. For pregnancies that are carried through less severe malnutrition, this will make the baby’s brain weight lower than normal, with fewer neurons and glial cells – a permanent change. That isn’t what happens in autism – but the takeaway here is that brains can only grow from whatever is eaten. You can leverage this to support the brain throughout your child’s life.
Nutrition continues to be crucial to brain development and growth once your baby is born. If nutrition is weak in the first years, your baby’s brain will have fewer glial cells, reduced myelination, and less synaptogenesis. In fact, there are five major processes that allow a human brain to grow and develop. While many processes unfurl to sprout a brain in a cranium, all of them are vulnerable to nutrition deficits. None of them happen to potential, without adequate food and nutrition. Impeding any one of these processes can lead to developmental features that can affect people with autism.
This all starts when you’re pregnant and depends entirely on what you eat. It doesn’t stop until the end of adolescence, and in that window, brains still depend on whatever is eaten, to build and run themselves. Kids’ brains need almost twice the energy of an adult’s, just for starters! The academic evidence base is rich, deep, and decades-long, when it comes to describing how nutrients and energy from food let the brain do its job.
With access to all the protein, fat, minerals, amino acids, vitamins, and energy that brains need to build themselves, and barring exposure to neuron-wilting toxins, brains can acquire skill. They sort, process, remember, learn, regulate, manage sensory inputs, and control motor functions. They run basal metabolic functions for us, like breathing, sleeping, filtering our blood and lymph, and digesting. Though there are critical windows and various periods of faster growth, the bottom line is that a child with a developmental diagnosis owes his or her brain every possible leg up, to be able to develop into an independent, functional, and contented adult, regardless of diagnostic status.
What’s the deal with autism and nutrition? What could nutrition have to do with your child and a new autism diagnosis? Big topic.
Your Care Team May Not Know What To Do About Nutrition… I’ve worked with children on the spectrum since 1999, providing nutrition assessment, support, and intervention. I’ve authored books on it, trained other professionals in autism and nutrition, blogged on it, and lectured on it. I’ve completed hundreds of nutrition assessments and care plans for kids with autism, from all over the US and in other countries. And guess what: I have never met a child on the spectrum free of a nutrition concern. In most cases, nobody on the child’s care team had ever looked for these problems. But when we found them, and fixed them, these children’s lives began to improve dramatically.
This happens all the time. Why? Because your neurologist, speech therapist, pediatrician, occupational therapist, and neuropsychologist aren’t nutritionists. It’s not their job to do this assessment, and they aren’t trained or expected to do it. But it’s well known that autism and nutrition is a thing. It’s just not their thing.
In most cases, nobody on the child’s care team had ever looked for these problems.
Common nutrition problems for children with autism go beyond low status for zinc or iron, eating narrow diets, missing out on varied proteins, lacking brain-critical fats or oils, or having tantrums that exhaust you at mealtimes. Kids on the spectrum do often have those problems, and solving them will improve behavior and functioning.
The Autism-Nutrition Puzzle Is Deep And Varied, And You Deserve Professional Guidance… There’s much more to the nutrition puzzle, and new research on this is emerging all the time. More often than typically developing kids, kids with autism also have problems with digestion, constipation, diarrhea, stomach pain, gas, or just plain eating. Besides eating poor diets more often that can leave them malnourished, they may lose a lot of nutrition because of diarrhea, chronic loose stools, or gut microbes that steal nutrients before they are absorbed. Gut microbes can even alter the pH of your child’s digestive tract enough to make absorbing certain nutrients difficult – further impeding how nutrients like iron or zinc get to the brain. Both are critical for attention and focus!
Solutions for these problems depend on thorough nutrition assessment. This defines the baseline, and makes plain what food or nutrition piece to tackle first. Professional nutrition assessment has many pieces, including lab work, nutrition focused physical exam, food diaries, and history. Lab tests alone are not enough for pediatric nutrition assessment.
Pivotal for a child with autism is assessing and correcting the gut biome. This is doable, and results can be remarkable – for behavior, appetite, picky eating resolution, and fixing constipation once and for all. The gut biome plays a role in brain development according to several studies (here’s just one), and gut bacteria contributes directly to autism-like behaviors, according to mounting research. Optimize this piece of your child’s autism puzzle, and you are likely to see remarkable changes. Get guidance – just tinkering with probiotics is not likely to have a therapeutic benefit.
In my practice, I assess gut biome with stool culture that includes fungal species, beneficial flora, disruptive opportunistic bacteria, and pathogen bacteria. I also use PCR DNA stool studies – a more sensitive method than culture – to find parasites, protozoans, viruses, and more. Learn more here about why basic pathogen stool culture or antigen studies may not do enough to solve this piece of the puzzle for your child with autism.
Special Diets Are Not Unsafe… What about special diets for autism? I never recommend any diet without a rationale made clear to me from labs, symptoms, history, and clinical signs. Whatever diet your child eats, it should be tailored to your child, through individualized assessment and care. Your child is worth it. Don’t jump on a dogma bandwagon – get clinical facts that describe your child’s situation. I have witnessed tremendous turn-arounds in children with autism whom I placed on restricted diets. Monitoring is the key, as is replacing what you remove with equal or even better food.
Contrary to the story you may have heard that elimination diets are risky, I have never found this to be true. I instead see that these children become healthier, happier, and end up with a broader palate overall, thus getting more nutrition and food, and growing better, sleeping better, learning better, and settling down into their true selves. What is risky is leaving a child in picky eater mode, unable to eat more than a few foods, or waiting years until all other interventions fail before providing good nutrition care. You will have missed opportunities for brain development that only happen in time sensitive windows at younger ages.
I have also not found that children suffer socially when using dietary restrictions typical with an autism diagnosis. Instead I routinely witness that because behavior and social skills rapidly improve with the right nutrition support, children with autism become more socially engaged, make more friends, and get more access to social landscapes as a result. Kids tend to choose to be with their new best friends, rather than their old favorite food.
New autism diagnosis? Put nutrition first. It’s just the tippy top of the iceberg of potential! All those other services you’re looking at right now, and wondering how to pay for, work far better when paired with the right nutrition platform. Your child will get more mileage out of each intervention, whichever one you choose. In fact, you may even find you need fewer services or less intensive services, once nutrition support is engaged. I have witnessed many instances of children graduating sooner that expected out of Applied Behavior Analysis, feeding clinics, or social skill groups because of a nutrition piece.
Get Autism Nutrition Help Now! Not sure where to start? Here are two of my books on autism and nutrition here and here. Contact me for one on one nutrition consultation if you’re ready to dive in with support.