Picky eating is for real. No, you didn’t cause it by feeding the wrong foods or being a bad parent. It may have snuck up on your child through background noise in the digestive tract that nobody noticed! Good news: Picky eaters can make full turn arounds, and it may be easier than you think.
Picky eaters can get entrenched enough to profoundly affect their health, development, and functioning. Reversing picky eater behavior focuses mostly on that – behavior. Therapists strategize on how to present food, how to desensitize toddlers and kids to new food textures, and of course, on ruling out any mechanical swallowing concerns (important to rule out with your pediatric OT or SPL). It’s a slow, arduous process. There are many dozens of specialist clinics for pediatric feeding disorders in the US (find one here if you like!) that will work with young children with this approach, to teach new habits and less defensiveness around food.
But what I always wondered is this: Why did picky eating even become a thing in the first place? It truly did not used to be. No, we are not all that much smarter at noticing this stuff than we were a generation ago. Kids mostly just… ate. Sure, some of us had our finicky stretches. But this was so not in the pediatric nutrition landscape that my training – graduate, undergraduate, and clinical rotations – made zero mention of the extreme picky eating now so common in kids: Picky eater behavior bad enough to cause growth failure, malnutrition, frequent infections, need for a feeding tube, or clinical intervention.
What happened? This was the question for me, as a dietitian nutritionist working with these kids. Why would a child “choose” to start aversive eating – in infancy? Or even as an older kid, when the diagnosis might become “avoidant restrictive eating disorder” (ARFID). I couldn’t get my head around that part. I figured there has to be a reason why this gets rolling in the first place.
ARFID diagnostic criteria include this statement: “The eating disturbance is not attributable to a concurrent medical condition”.
Is that true? Or maybe the problem is … we need to do a better job of ruling that out.
When things are out of balance in the stomach and digestive tract, or when certain nutrients are depleted, kids become picky. Very picky, and their desire or even tolerance for food can drop out (same with elders, whose stomach acid diminishes in later years, and who are often given medications that stop appetite). Identify and fix these out-of-balance issues, and appetite can be restored. I have supported kids in this very way, many times in my clinical pediatric nutrition practice. And they make brilliant turn arounds. They eat, they poop, they stop throwing up or gagging, and they grow. But best of all, they go out and play again and they stop worrying about food.
In the kids who have come into my practice with ARFID, picky eating, and growth failure from these circumstances, I usually find that there has been no nutrition screening done for them – not even basic lab studies to screen for the most ordinary, but highly impactful, nutrition deficits that can mess with appetite. I’m often the first to look! I will scrutinize causes for things that can cause pain, or make a child feel full all the time, or trigger gagging and texture aversions. And, I find them.
What this means is that picky eater “behavior” is often not so much a behavior as a response to the body trying to cope with something out of balance. Eventually kids will develop behavioral responses that seem counterproductive and exasperating to us adults – as they experience stress from being forced to try to eat things that they can’t digest, or to eat foods that may cause pain they can’t verbalize.
Here are some nutrition and gut features that will trigger or worsen picky eating:
- Reflux medicines, current or past – these diminish stomach acid over time, which eventually leave the stomach sensing that it’s “full”. End of appetite. These also encourage fungal microbes to grow in digestive tract, which can cause gas, more reflux, and picky cravings for starchy food. Finally, they prevent absorption of minerals and B vitamins, which can also affect what you feel like eating.
- Antibiotic use – whether these were given to a child, a child was exposed in utero, during delivery, or through mom’s breast milk, these can alter gut microbe balance enough to disrupt appetite and eliminations – especially when exposures occur in the first weeks or months of life.
- Poor iron status – Anemia and pre-anemia (weak iron status or ferritin with normal hemoglobin level) will cause peculiar cravings (a condition called pica), and at the same time, make appetite overall weaker and more picky.
- Poor zinc status – this tends to worsen oral texture aversions, gagging, and refusal of anything but that one favored texture (usually, crunchy starchy snack food). Mixed foods will cause gagging. These are kids who love biting stuff like erasers, pencils, rubber chew toys, or… other kids!
- Overgrowth of opportunistic bacteria or yeasts in the gut – microbes move in thanks to the ever worsening picky eater diet and/or reflux medicines and/or antibiotics. Helpful microbes are not be able to stick around. The vicious cycle begins. More overgrowth of the wrong microbes –> more reflux –> less digestion –> more pain, nausea, constipation, diarrhea. Appetite drops. These junky microbes are not necessarily pathogens (like Salmonella or Giardia) but I have been the first to find those too on occasion, using more sensitive stool studies than your insurer paid your GI doctor to use.
- Leaky gut has allowed poorly digested proteins from milk and wheat to enter the body in a form that mimics opiates. These are called casomorphin (morphine like molecule from casein, which is cow’s milk protein) and gliadorphin (morphine like molecule from gliadin, which is part of wheat protein). Guess what? These opiate like protein fragments are super addicting. This child will not want any food that is not made of casein or gluten – picky eating, full on. See my Milk Addicted Kids e book for more on this one.
- An existing, unresolved FPIES diagnosis that continues to make eating traumatic.
- Endoscopies, celiac blood tests, and basic lab screenings like CBC and chemistry panels will often look normal – but all these other issues can be in play, wrecking your kid’s appetite.
Back to my original question. Why did picky eater behavior ever even become such a thing, to the degree that we have clinics in every city to help change this behavior?
In my view, barring mechanical or structural impediments to normal feeding, picky eating has been caused by overmedication of kids in the last generation or so. Before oral antibiotics were so widely used, before so many early doses of vaccinations were given in the first two years, before reflux medications became so popular for infants and kids, our gut biomes evolved naturally. This allowed normal appetite and digestive skill to progress uninterrupted. But since the late 1980s, we “interrupt” this process with pharmaceuticals from birth on.
When digestion is in tact, appetite evolves naturally, and vice versa. Many kids I’ve worked with have spontaneously changed eating habits once they have comfort and ease with digesting food. Screening for nutrition problems that disrupt this process can go far in helping your child enjoy food more readily, and to become a relaxed eater for greater variety.
This does get harder for older kids who have experienced more pain, trauma and frustration with feeding clinics that failed for them. Many of them also go on to fail with psychiatric medications, as they are diagnosed with having a “behavior” problem rather than a physical one. Eating disorders with a psychological component need help on both levels – with counseling and support, and good nutrition screening and strategizing.
Early on, protect your baby’s gut by letting it develop its innate skill for digesting and enjoying food. Use antibiotics only when truly necessary with your doctor’s guidance. Use restorative probiotics and pre-biotic foods. Consider spreading out, delaying, or deferring vaccinations until your baby is older, especially if you are breastfeeding – which gives the protective immunoglobulins and immune defenses that your baby needs. You might be amazed to see the progression of a healthy appetite in action!
For toddlers and older kids who are picky, stay tuned for resources on busting this pattern by following me on facebook here. Repairing gut dysbiosis, replenishing imbalanced minerals, and addressing other underlying problems can turn this around.
I’m a pediatric nutritionist with long experience, and I wish you’d stop talking so much about food and nutrition with your kids.
That sounds crazy, I know. Food and nutrition are absolutely pivotal for your kids’ brains, behavior, growth, mood, learning… everything. No wonder then that food, recipes, and nutrition talk are all over the internet and mom blogger universe. From how to make killer bento lunches to keto for kids (mistake, BTW, unless under certain circumstances), everyone has something to say.
The good thing about this is that we are all woke now on the importance of what we eat, where food comes from, and how we grow it, whether it’s chickens, chocolate, or chard. We really are what we eat. We eat, and we turn the food into us – hair, bones, teeth, mood, and all. Period. That’s pretty much it (though a lot can go wrong along that path.. fixing that for kids is pretty much what I do).
But… there is a HUGE downside, and it’s bad for kids. It creates undue anxiety, stress, and overwhelm for kids, young ones and teens alike. It really stresses moms out too. I run into this often in my clinical practice, and I can tell you that it has gotten worse as our (justified!) enthusiasm for whole, healthy foods has exploded in the last 10-15 years. You’ll want to avoid these pitfalls with your kids. Here’s my list of Fail vs Fabulous, when encouraging healthy nutrition and food habits in your family.
It’s so easy to label a food “good” or “bad”. There’s plenty of junk out there, including organic junk. Obviously, it isn’t what kids should live on. But don’t drill these labels into your kids’ minds. What they need to learn is discernment – and they will. Eventually, ideally, when they’re out and about on their own without you, those “bad” foods should be neutral to them.
What do I mean by “neutral”? I mean that the idea of eating that food doesn’t provoke anxiety. It isn’t even compelling, because it was never forbidden in the first place. It doesn’t elicit judgment or shaming for themselves, or toward friends and peers who eat those foods.
As long as there is no safety or egregious comfort issue – as in, needing an Epi Pen, or a vomit-to-shock (FPIES) reaction, hives, migraine, nausea, bloating, burning diarrhea, disabling gas pain – then let kids have forays into junk. Not daily staples or regular snacks, mind you, but occasional dabbling.
Instead: Provide treats for special occasions (or every so often for no reason other than it’s fun) with no discussion about whether it’s “good” or “bad”. Again, safety issues and food allergens or triggers aside, simply make or buy some fun food, and let your child enjoy, care-free.
My one exception: Spoiled food. This IS bad and dangerous and kids need to learn that too. So, tell them.
2 – Don’t Expect A Young Child to Have Discernment (or even care)
Speaking of discernment, forget needing your four year old to have it. That’s your job. Children do not need to know what organic is, or glyphosate, or MSG, colors, additives, gluten or what have you. They shouldn’t care either. They’re little and they have much more important stuff going on in their little worlds. Please stop walking them through the supermarket and asking them to pay attention to labels or what you’re buying. Believe me, they are observing. They don’t need the specifics, and this will only be information overload that can lead to anxiety or meal time control battles. They need you to be chill, in charge, and happy that you’re with them (most the time). That’s about it.
Instead: Lead by example. Say less, do more. If your child accompanies you shopping, let them day dream and leave them alone; if they love chatter, join them in the randomness of it. Your child doesn’t need every moment to be teachable!
If they see something truly junky or sugary or processed that they pitch a fit for (and they will, because supermarkets place colorful cartoony packaging at your child’s eye level on purpose), that’s your call. Sometimes we can get away with floating to the next aisle with a soothing “Hmm no I don’t want to do that today” (and refrain from giving a reason why). Other days, you know the both of you don’t have it in you to make it home without giving in. Up to you, but avoid each supermarket trip rewarded with a junk treat.
If you’re in servitude to your stove or kitchen and miserable making all this scratch beautiful food, guess what – your kids know. Even your baby can tell. The most important thing here is that you get to be happy and enjoy food. Even if there are stressors, including big ones, about what can be safely eaten in your household, endeavor to find the joy in some of it. Joy is, above all else, why we’re here.
3 – Stop Explaining Everything and Stop Feeling Sorry For Your Kids with Diet Restrictions
You’re in charge. You’re the adult. If you know your child does poorly with a particular food, and they are fiendish about getting it and asking for it constantly anyway, oh well! You know best and have decided that they’re not going to have that food, period. Remember: This goes for foods that are a known danger or debilitating to your child – not for foods that are imperfect, but harmless.
Explaining and justifying your parenting choices to a young child (or even a teen) is, um, a bad idea. Doing so engenders entitlement in your child, which can make their opposition and protests even bigger. In little ones, expect tantrums, anxiety, and meltdowns when you try the “here’s why” route. In teens, expect impressive arguments, brooding, and door slamming. Most of all, don’t expect or need your kids to agree with you.
Instead: If a child asks for a reason why, offer it in the most developmentally concrete way for that child’s age. Refrain from volunteering comments like “it’s bad for you” or “will make you sick” or “your body can’t have that.” Don’t label the food or your child’s body as defective or bad.
Younger kids can be redirected with “there isn’t any more of that at the store so I found this one instead” or “I think this will feel really good in your tummy. Let’s try it and you let me know.”
Teens are reaching a point of practicing discernment on their own. Experimentation and screw ups are par for the course at this age. Let them experience the discomfort of eating the wrong food. You will decide when you have had enough as a parent: “I realize this isn’t what you want, but I am the one taking care of/rescuing you each time you feel sick from eating xyz. So, that food is no longer going to be in the house, and I won’t buy it anymore. If you eat it on purpose outside of here, I won’t be able to help you.” And then there’s always “..because I am the one buying the food, and I said so.”
4 – Stop Feeding Your Kids Like They’re Gwyneth Paltrow (or expecting them to like it)
Oh dear. How many, many food diaries I have seen that look this beautiful: Green smoothies, pumpkin seeds, sprouted Einkorn homemade bread, kombucha, fermented kvass, homemade dosa, coconut flour pancakes, avocado toast, bone broth… Or, a list of light veggie snacks all day long: Carrots, celery, nori, cucumbers, and apple slices with a few cashews. Or, a food diary that shows me 120 grams of protein and less than 60 grams of carbs (a nearly ketogenic intake).
Those are beautiful foods. Some kids really love this stuff. But, usually, it turns out this is a little dysfunctional. There are too many food rules in the house, and it’s causing tension to comply so stringently with eating only organic, perfect whole foods.
I’ll also usually discover that in these households, kids are falling off their growth patterns, experiencing stunting, or underweight. What tends to happen here is kids end up low for total calories, low for carbohydrates, and high for fats and protein. This is a great eating style for adults (who are not growing), but it can cause stunting and underweight in children.
Here is a common anecdote from my practice: I began working with a mom whose child was eating an overly restricted diet. Mom removed all processed foods entirely, based on the belief that any of them, at any time, are bad. Her child also happened to be a picky eater and refused many textures, limiting her choices more. On top of this, based on a misinterpreted blood test for a food sensitivity panel that the mom had somehow done on her own prior to our meeting, the child was only allowed to eat 7 foods, and had been eating this very restricted diet for years. She was not growing, had miserable behavior and sleep problems, and was trending toward anemia.
It turned out, right off the bat, the child could eat many foods that mom had wrongly assumed were trouble. A shift in view point on the good vs bad food mythology helped a lot. The child’s behavior improved immediately and she gained some much needed weight. Finally, her brain and body were getting replenished.
But even after a few sessions, things didn’t sound quite right. So I asked for an updated food diary. Mom shared a usual day food intake of small quantities, throughout the day, of raisins, peanuts, maple syrup, rice, potato chips, and a brownie. That was it. That was a usual day of food. This explained the re-emerging problems: No protein, no good fats or oils, too little food over all, a grazing pattern, and few micronutrient rich foods (for vitamins and minerals).
Mom said this child would sometimes eat chicken. So I asked – what if you gave a chicken nugget, would she like that, or try it?
A big silence followed. Mom was stunned. She had never done that, and wouldn’t, “because, you know, they’re so junky.” We agreed to give it a try after a quick search gave us some brand options she could live with. There are ready to heat and eat versions of this stuff that aren’t so terrible, or are gluten free too.
Instead – This child was already eating a junky poor diet. It didn’t matter if the peanuts and maple syrup were organic. Those alone don’t make up a whole foods diet. So, toss in some fun. Find some ready to serve, heat-and-eat stuff so you don’t have to work so hard cooking it all from scratch. If you hit on something, then you can make your own scratch version even better if you like.
Let kids be kids. They need different diets than adults. They shouldn’t be eating they way you do, most likely. Peruse my blog for more ideas and tips on how kids eat, what they need, and some recipes to try.
• 5 – Baby Led Weaning Is Great… For Babies
No, babies and children don’t know what they need all the time, and don’t necessarily have a keen inner wisdom that they can tap at a moment’s notice. Some babies wean because they feel eager and ready to move on. Some can’t get there, and won’t, even when it is safer and healthier for them to do so. Don’t pressure your young child to know everything. I’ve met many toddlers way past the day they needed to wean, and mom is still waiting for permission to do so. Nope nope nope. You’re in charge, mom.
Likewise, toddlers and kids need direction too. Weaned or not, presenting food all day long in a parade of choices is often just plain overwhelming and frustrating for little kids. It’s too demanding to expect that they will know what to do. This strategy can create anxiety in young kids, while mom or dad get super frustrated by the poor growth and picky appetite that this can often trigger too.
- Don’t expect them to guide you in making their food choices. Sure they will have their preferences, but it is your job to feed them.
- Don’t expect that they will always know or verbalize when they’re full or when they’re hungry. Especially when kids have used reflux medicines, appetite and its cues will be weakened over time. If you need help with this, contact me or speak to your pediatrician.
- Don’t chatter about how important food is. Just make or buy something you love to share and enjoy with your family.
- Don’t allow non stop grazing. Toddlers and young kids grow, sleep, and behave better with distinct snack times and mealtimes.
- Don’t limit texture options to just pincer grasp foods and pouches. Kids can be rigid. The longer you wait for them to reach for a new food, the longer you may be waiting. I’ve met several four and five year olds who don’t know how to chew. It’s ok to rock their world a bit and expect them to progress much earlier on.
Instead – Make food a benign or pleasant background piece. At snack or meal times, it’s just there, beckoning. Allow a choice between 2, maybe 3 foods at most. Present mixed textures and novelty, including foods that might be messy or that require mastery of a utensil. Let your child feed himself or get messy. Good help can be had with a pediatric occupational therapist if need be – let your doctor know you’d like help, and get a referral, if feeding is so stalled that your child isn’t growing or gaining well.
I really meant it …
…when I said that the most important reason why we are all here is joy. Eating and food are great paths to create it, share it, grow it. More than anything you say or do around food in your household, making food a generally positive, inquisitive, and expansive experience is what will create good self care and eating habits in your growing family. For extreme picky eaters, you may have other problems afoot that need tackling. Check out my e book here for more details on how to redirect that too.
Can you even remember not knowing the word “covid”? We’ve spent most of 2020 locked down, wearing masks, avoiding travel, skipping the gym, refusing social contact, learning and working from home (if you still have your job), deferring doctor’s appointments and health care, and cooking at home all the time. We’ve lost loved ones, some of whom have died alone due to strict covid lockdown rules. We’ve lost connection with our communities.
So why is this virus still here, and apparently, flourishing? Didn’t all this effort matter?
I recently asked a colleague to assist me with a regression analysis to examine how states with the earliest and strictest lockdown measures fared, in terms of their death rates from covid. Did more lockdown measures mean reduced death rates?
What we found might surprise you – it sure surprised me!
We used data (compiled here) that gave each state a ranking for its lockdown measures. We plotted this against covid death rate by state. Here’s what we found, as of mid October 2020:
Each dot is a state, and you can see that the states are pretty well scattered around. This implies that the correlation between restrictions and death rates, if there is one at all, is probably weak, and that other variables are in play. But, we needed the regression analysis, to show for sure if this was true.
Here’s what happened: The red line shown in this graph is where the regression analysis fell. A weak correlation was found, showing that more restrictions were weakly correlated with higher death rate.
In other words, states with more restrictions had higher death rates – the exact opposite of what we expected!
This analysis brings up a lot of questions: Did tougher lockdown measures create more collateral deaths? Or were they not strict enough? Is this why covid is making a comeback right now? If we depend so completely on lockdowns and nothing else, this analysis suggests we may continue to lose the fight against covid.
This analysis does not evaluate cause, only correlation. We all know correlation is not cause. And it is by no means the only analysis we should be performing.
But it begs the question: Are we moving in the wrong direction?
The costs of unilateral masking, lockdowns, restrictions and quarantines have created unsatisfying results, to say the least. Every day, we are bombarded with reports of covid cases on the rise. But little information is reported about death rates (which are not cases, and are also not the same as the numbers of deaths). There is some hopeful news on that score – look at this from California – we can all appreciate this bright spot that deaths are not necessarily increasing as the case number rise, as they did last spring.
When this happens, one possibility is that the virus has mutated to a less lethal form. Another is that treatments may have improved. Surely other possibilities are in play. The frustrating piece for me – as a clinician, and as a professional with public health training – is that no one seems to be asking these questions.
Many of us are stuck in the fear-narrative. Even my scientist friends – geologists, oceanographers, climatologists, engineers, computer scientists – people who pride themselves on being able to understand complex problems – can’t seem to leave the news narrative behind, and embrace some hard facts about this virus and how it behaves in our population.
Once the brain is in fear, it literally can’t reason, or listen. Fear creates distraction. Once we are entrenched enough in fear, we are no longer capable of critical thinking. And it seems this is where the media narrative has led many of us.
We have been told that masks, lockdowns, and closures are all we’ve got to stop the virus, until a vaccine shows up. Fines, arrests, and public shaming have become routine for those who question lockdown strategy. Is this right?
The economic losses, isolation, mental health crises, suicide in teens, loss of loved ones who died alone due to restrictions on visitation; not being able to bury our lost loved ones, or process their deaths, with funeral gatherings prohibited; collateral deaths from lack of access to health care; reduced health from losing access to fitness facilities … the devastation and toll of covid has reached every corner. This is not to even mention the economic losses from lockdowns, staggering in themselves. We have all been affected. I know virtually no one who has not personally experienced loss, tragedy, illness or extreme stress from the covid crisis of 2020.
If we are going to be putting our society through all these restrictions, they better be working, and it appears they have not done what we had hoped.
Restrictive strategies, no doubt, make sense and are effective in certain places: Health care spaces, closed environments, airplanes and so forth. But imposing them indiscriminately, universally, outdoors, or without criteria for who is at risk has cost society too much, and it has not created the result that we are told it is creating.
We need better strategies to meet this challenge.
If you remember the SARS virus outbreak from 2002, you know that corona viruses are not new – but they do work differently than ordinary seasonal flu viruses once they infect a host, and can become dangerous quickly, in susceptible persons. Corona viruses have the largest genome of all the RNA viruses, so they are especially good at producing new variants (that is, mutating quickly), and this may be what we are now seeing with COVID-19. This makes vaccine development an exceptional challenge. Read more here about some of those challenges.
Another suprising piece of covid news that we analyzed: Flu vaccination correlates with higher death rates for covid. We plotted flu shot uptake by state in children against covid death rate by state. Here’s how it fell:
We found a positive correlation between higher covid death rate and percentage of children who received flu shots. States that had higher compliance for children receiving flu shots also had higher covid death rates. Flu shot data came from this CDC site, while state lockdown score came from here.
Once again, this is a correlation. It does not mean flu shots cause covid deaths. It means that perhaps, getting a flu shot isn’t protective as we have been told it is. It may also be a clue as to why some children who seem quite healthy have died from covid, and at the very least, warrants more research.
Whether a flu shot will help or hurt us in fighting covid is a question that some researchers actually looked at. The findings were not what you might expect: Flu shots increased risk of getting corona virus.
Your immune system depends on nutrition and food to build its components and do its work. Masks and restrictions have not done the job we hoped they would, and may be inadvertently making the crisis worse. Flu shots may not help as much as we would like to think either. These possibilities need analysis and critical thinking, and we can’t access that when we are in fear.
Meanwhile, do all you can at home. Maybe shut off your news feed for a bit. Learn here about how you can support strong immune function in your family with food and nutrition. Leverage these to manage covid better for your family. And, keep a calm, open mind – the answers to this pandemic may come in unexpected ways.
Covid is still here, unbelievably – so what can you do to beat it?
You’ve probably heard about inflammatory cytokine storms that can trip a COVID-19 infection from mild and easily beaten, to prolonged, dangerous, or even fatal. Luckily, so far, it appears this happens to a only small percentage of those who get infected: Mortality (death) rates vary, hovering from less than 1 percent to 4-5%. The Americas are the worst place to be. What are we doing wrong?
The role of background inflammation in making COVID a riskier matter is clear. Persons with diabetes, coronary vascular disease, hypertension, or heart disease show significantly higher risk for hospitalization (asthma was at first thought to elevate risk for complications and death, but newer data have not borne this out). All these conditions have an inflammatory component. Lots of people are walking around with no idea that they have background inflammation, or the nutrition problems that go with that. For example…
- Our health care system is so bad at paying attention to food and nutrition concerns that it can take six to ten years to diagnose celiac disease, a debilitating sensitivity to gluten (wheat) that escalates to autoimmune disease. Just one simple, cheap blood test is all it takes to diagnose celiac disease; add one more to the lab order, and you can capture gluten sensitivity years before it escalates into celiac disease.
- Autoimmune thyroid disorders affect nearly 30 million people in the US, but these can go undiagnosed or misdiagnosed for years.
- Many times, I have been the first and only clinician to capture elevated calprotectin on stool testing for a child. Calprotectin is an inflammatory marker that typically attends extensive gut dysbiosis or inflammatory conditions like Crohn’s disease. It is a biomarker for colitis, enteritis, and even rheumatoid arthritis. Prior to my screening, no one knew these children – who were suffering and symptomatic – had background inflammation.
I believe undiagnosed background inflammatory conditions or processes are part of why some die so quickly from covid, including children, or young strong adults. Was there an unknown, undiagnosed background piece for inflammation that elevated that person’s risk?
Few of the kids in my pediatric nutrition practice ever had screening for inflammation, or for nutrition concerns, before working with me. This is a problem, because your immune system depends on nutrition to function.
In kids, this is very important. The lower a child’s nutrition status, the more likely that child is to get sick more often, have more complicated and longer illnesses, or even die, from infectious diseases. In fact, the single most predictive measure of how a child will fare through an illness is nutrition status, a fact that has been understood for decades. This means that a lot of folks including kids and seemingly well young adults are walking around with the ticking-time-bomb, double-whammy set up of background inflammation plus a dearth of the nutrients you need to manage inflammation and infection!
Besides finding weaknesses for critical immune-supporting nutrients (iron, zinc, vitamin A, vitamin D, protein ), nutrition screenings can pick up inflammation signals on routine bloodwork. I screen for this stuff and fix it in my pediatric nutrition practice. Parents are often pleasantly surprised when, after working with me, their kids rarely get sick (and they have more energy, sleep better, and are happier too).
I believe that part of the variation we are seeing in covid infections and deaths is directly related to nutrition. Nutrition assessment is not part of routine pediatric care, and advising families on how to navigate nutrition concerns for kids certainly isn’t either! When was the last time your pediatrician told you what to make for dinner, or how to pack a lunch your picky eater would actually finish? Lol. Never. Here are five ways to build a strong immunity-foundation for your kids:
1 – Feed Your Kids – Lots! The one factor that most determines how a child weathers an illness or infection is nutrition status. And, the single most important nutrition parameter for a child is growth pattern. This is the single most important nutrition parameter for a child, period. Not whether they eat fermented food, follow a GAPS diet, or never eat sugar. Nope. In children, when it comes to fighting infection, it’s all about body resources and nutrient stores. So, make sure that your kids maintain a healthy weight before illness strikes. Underweight children as well as overweight kids are more likely to get sick more often, stay sick longer, and have more complications than children in normal weight status. This fact is based on decades of global data on childhood illness and child mortality. Because the immune system pulls on stored nutrient resources during illness, and because some of those resources are stored protein and energy in our own tissues, even slightly underweight children can have higher risk for infections and poor outcomes. Your child does not have to be visibly emaciated or even below the 5th percentile for weight for age, in order to be clinically underweight. Your doctor may not have noticed a growth impairment, so visit my blog on underweight in children to see if your child falls in this category.
- Don’t fear carbs or over-restrict them. Instead, load up on healthy vegetable source carbohydrates like sweet potato fries, plantain chips, squashes, chick peas, berries, apples, mango, carrot, pea pods, cassava tortillas (if corn is a fail), sprouted grains or seeds, or legumes; or allow whole grains and GF grains as tolerated. Carbs help kids gain and grow, and a healthy gut will readily and comfortably use them. Recipes from my blog that fit the bill: Portuguese Kale Soup, Spicy Chick Pea Curry, and Pumpkin and Lentil Dahl.
- Too much protein can be as ineffective as too little protein in a child’s diet. Generally, children need anywhere from 35 grams (toddlers) to 50-60 grams (bigger school age kids) or as much as 70-80 grams (big high school athletes with rigorous work outs) of protein daily, depending on their growth status and activity levels.
- During illness, protein losses can increase. Use two extra servings daily for protein rich foods like bone broth, collagen, fish, legumes, meats or poultry, any safe nuts/seeds or their butters.
- Immune (and lung) helpers like vitamins A and D need to be eaten with fats or oils, to be absorbed and stored. Let your kids eat plenty of healthy fats like olive oil, grass fed butter or ghee, organic grass fed meats, coconut milk or oil, egg yolks, avocado, nuts/seeds and their butters, or fish oils.
- Eat mineral rich foods for zinc and iron; both are immune-critical helpers that are often low in kids’ diets and are readily spent when we get sick. Go for nuts, seeds, vegetables, legumes, juiced greens, bone broth, egg yolks, pork, lamb, or beef; unsweetened cocoa or dark chocolate is zinc rich too! If some of these don’t go in your kids’ mouths every day, use a supplement. 30 mg zinc daily is a start; kids may need more depending on their status. Iron is toxic at high doses, so ask your doctor what dose to start with in your child’s case. Fun fact: A clinical sign of poor zinc status is losing your sense of taste and smell. Sound familiar? This is also a key feature of covid infection, indicating that the body is ripping through whatever zinc it has on hand to fight.
2 – Probiotics Help Lungs Too
- Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Bifido lactis have been shown to help lung tissue protect itself from invading pathogens. If a probiotic isn’t in your child’s regular rotation, consider adding one that includes these strains, such as Allergy Research Group Lactobacillus or Klaire Labs Therbiotic Factor 6.
3 – Use Antioxidants During Illness
- Vitamin C as sodium ascorbate in high doses is a strong antioxidant that may help beat viruses. Use doses in the multi gram range, not milligrams, eg a 50 lb child can use 5 grams of Vitamin C daily if this doesn’t upset stomach. Split doses throughout the day for better tolerance.
- N-Acetyl Cysteine (NAC) is an amino acid we use to make glutathione, our body’s top go-to for detoxification and antioxidant actions – especially for lung tissue. NAC also helps break down mucus in lung tissue. In my practice, I have used 600-1200 mg NAC daily in school aged children. It can be used in multigram doses as well (a common support for anxiety or OCD).
4 – Use Immune Modulating and Virus-Killing Herbal Supports
- Houttuynia cordata herb (available as drops from Nutramedix) showed anti-corona virus activity in this animal study from 2016.
- Cilia are tiny hair like cells that beat debris and mucus up and out of our lung tissue. Corona viruses target these delicate structures, causing more fluid and debris to build up. Protective herbs for cilia include olive leaf extract and berberine. See Barlean’s Olive Leaf Extract liquid and Core Berberine from Energetix; you can also use a glycerite based goldenseal tincture as a berberine source.
- Corona viruses attack by attaching to a key protein on cell surfaces called ACE-2, which has the important job of regulating vascular constriction. Once ACE-2 is disrupted, fluid can enter the lungs more easily… and fast. The body responds with strong inflammatory cascades, but this can make the infection worse. Chinese Skullcap, horse chestnut, elderberry, cinnamon, and licoriceroot make it harder for the virus to attach. Resveratrol can reduce inflammatory cytokine response. All of these products are available in various formats easy to give to children (tinctures, drops, powders, and in some cases, chewables).
5 – Give Direct Immune Support
- Immunoglobulins are immune proteins that we make to protect ourselves. They are found in breast milk and in colostrum, and are quite effective at protecting newborns and babies! You can also now purchase a dairy free, hypoallergenic, bovine serum derived immunoglobulin supplement and use it daily to boost immunity. See Orthomolecular Research brand for SBI Protect. I use this often in my practice for children of all ages, with good results. This is a tasteless powder that mixes readily in soft foods or liquids.
We may be facing the reality that there is no safe or effective vaccine for covid for a long time, if ever. As we learned before from the SARS virus, corona virus vaccines are exquisitely challenging to create.Two-thirds of those polled expressed that they would not take a covid vaccine, due to safety concerns. In the meantime, take action to support your kids’ immune systems so they can be as ready as possible. Bonus – they may breeze through winter with no colds or flu bugs at all!
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. In fact, a front runner vaccine candidate from summer 2020 triggered transverse myelitis – an incurable condition attacking the spinal cord – in three persons in its clinical trial. And the virus is similar enough to HIV – for which no vaccine has ever been successfully developed – to make it susceptible to the same fate: No vaccine with the durability, safety, or efficacy to really work.
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 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 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.