Everyone has heard about probiotics – but how do you know which are friendly and helpful, and which are UN-friendly and detrimental? Not all probiotics are all friendly, all the time. The microbes in probiotics vary in the sorts of tasks they do for us – so, depending on when, what, and how you’re using them, they can be a big help or a big fail.
Probiotics are bacteria or yeast supplements, in case you missed the memo, that you can buy and eat as a supplement. There are powders, capsules, chewables, probiotic foods and drinks… you name it, it’s out there. The idea is to help populate your intestine with the types of bacteria that keep you healthy. Turns out we really need bacteria, viral exposures, and even some fungal (yeast) species to co-exist with us. These help our immune systems stay robust and direct traffic – especially at the gut wall lining, where our insides meet the outside world.
What’s in a human gut biome, and what species of microbes do what, is a burgoening area of study in medicine and health. While the old paradigm believed in a kill-all-germs and take-no-prisoners approach to immune health, the new paradigm has noticed that this doesn’t really work – because it makes people have more allergy, more inflammatory conditions, more autoimmune problems, and possibly, more susceptibility to serious conditions later in life, like cancer. A great example of this is how exposure to infections like measles and chickenpox in childhood protect us later on from certain cancers or shingles. But, now that we so enthusiastically use antibiotics, vaccines, and cleansers to keep germs at bay, we’ve really altered our human immune-scape!
Enter probiotics. Using these really can help many conditions, symptoms, and problems – from asthma and allergies to colitis or obesity.
But what if you use them and your child feels worse?
You may be using the wrong probiotic at the wrong time for the job.
One of the most-often misused strains I encounter in my pediatric nutrition practice is Saccharomyces boulardii. “Sacc B” for short, this is actually a strain of yeast (not bacteria) that has shown some action against tough infections like Clostridia difficile (“C diff”), which has become antibiotic-resistant. C diff has become so resistant to antibiotics that the FDA even approved use of fecal transplants to fight it, so any tools to fight it are worth exploring. Sacc B has been shown to reduce symptoms of irritable bowel, inflammatory bowel, and even Candida infection. Sounds great, right?
But it can make your child feel sick and may trigger symptoms like diarrhea, nausea, bloating, picky appetite or rashes if you use it for too long (more than a month). If your child has antibody reactions to Candida or other Saccharomyces species, then using Sacc B may fail – because the body may attack the Sacc B with an immune response. Cross reaction can occur here, as Candida and Saccharomyces – though they are different species and strains – are all in the fungal family. And that can make Sacc B backfire for your child.
Solution? Withdraw the Sacc B if your child is feeling worse on it; or, don’t use it at all until you screen for antibodies (IgG/M/A) to Saccharomcyes cerevisaie and Candida species. You can also run a stool test for microbiology of these species, which should not be found in excess on your child’s sample.
If you use Sacc B, use it in short bursts, say 3 weeks at a time. Look for improvement then rotate off the Sacc B to mixed Lactobacillus and Bifido strain product, or a spore probiotic with Bacillus species. If no improvement, get professional guidance.
Another frequent fail in supplementing probiotics is using them when your child has small intestine bacterial overgrowth (SIBO) or small intestine fungal overgrowth (SIFO). Symptoms of SIBO and SIFO are similar to symptoms of other GI problems – which leads many parents to give probiotics a try. But, these can make SIBO or SIFO symptoms worse, and fast. A healthy small intestine (which is the first part of the intestine after the stomach) contains a lot fewer bacteria and microbes than the large intestine or colon (further down the pipe). Too much microbial action in the upper part feels awful. This is why kids with SIBO or SIFO often don’t like eating, are very picky, struggle with the slightest variations in food textures, or are even averse to feeding themselves. They may claim to be full when they’ve eaten very little. Add some multistrain probiotics, and this can make it all feel worse.
Solution: If your child is old enough to tolerate a SIBO breath test, you may wish to do this – but, I generally don’t use this test, because it is a tough test for a child to endure, especially if they do have SIBO! Your GI doctor may offer it, and you can ask about how to get your child through the test. If positive, you will need to address this before advancing a probiotic regimen. SIBO and SIFO can be helped with herbal supports and may not necessarily need antibiotic treatment. Once you do eradicate the SIBO or SIFO, single strain products at lower potencies can be helpful, such as Lactobacillus rhamnosus or reuteri at 20 billion CFU per day or less.
Now and then I’ll encounter a child who is downright over-dosed on probiotics by a well meaning parent. Many of us have felt enthusiastic about fermented foods like kombucha, sauerkraut, or kimchee, but overdoing it can create symptoms you’re trying to correct, like gas, bloating, pain, or food refusal. If you’re using these daily for your kids but they aren’t thriving with comfortable appetites and eliminations, revisit this strategy. I like to use a GI MAP PCR DNA stool screen as well as a stool microbiology test to look at what is going on. Sometimes a less aggressive strategy is better, and you can start by simply withdrawing fermented foods or probiotic supplements for a week or so, then resume at smaller doses. You may find your child simply doesn’t need so much probiotic supplementation, from any source.
Lastly, don’t confuse probiotics with pre-biotics. Pre-biotics are starches that friendly bacteria can ferment for us. Some kids (especially with FPIES) don’t tolerate pre-biotic supplements very well, because they may be high in FODMAPs. If you’ve chosen a product that has ingredients like inulin, chicory, galactic-oligosaccharides, cellulose, or maltodextrin, or if the label says “prebiotics”, take note – this may not be the one for your child. You can buy probiotics that omit these ingredients from brands like GutPro or Custom Probiotics.
The choices are dizzying in the world of probiotics, but the good news is there is probably a product that can help your child with appetite, eliminations, and more. If you’d like help, work with me to look deeper into what your child’s solutions might be.
Can you make an infant formula out of camel milk? I’m often asked to find substitutes when commercial formula fails or when even breast milk is triggering a baby’s FPIES, allergy, or eczema. There are many good formula options from cow or goat milks on the market – but some babies still struggle, and need yet another option.
Camel milk has many health benefits – some of which I outline in my post on it here.
And yes, you can make an infant formula using it – as long as you know a few caveats up front. Most of all, you can’t use camel milk in its original form as it comes from the camel. It must be modified first.
Camel milk is not the same as human milk, or milk from any other mammal like sheep, cows, or goats. It has to be modified to be safe as an infant formula, but it can be used to build a new formula (here are several links to research describing camel milk nutrition). Babies have very specific and very different needs than toddlers, children or adults when it comes to food and nutrition. If you miss the mark, your baby can pay the price with irreversible deficits in development or growth.
Camel milk has about half the fat of milks from cows or goats, and less than half the fat of your breast milk, especially early milk or colostrum. Babies need a lot of fat. It’s essential for all sorts of things, including brain growth, and for carrying critical path nutrients like vitamins A, D, E and K into tissues.
Camel milk also has more than twice as much protein than human breast milk – which might sound great at first. But human babies don’t need all this concentrated protein, and it can actually be harsh for their kidney tissue to eat too much of it too soon.
Lastly, camel milk has less carbohydrate in it that our own milk does. And babies need a lot of carbs too, because carbs become a primary fuel soon after birth – so protein and fats can do their own crucial jobs of building tissue, hormones, and carrying nutrients for us.
Less fat and less carb means camel milk has a lot fewer calories in it than human milk.
These macronutrient ratios – that is, the amounts of protein, carbs, fats, and calories in camel milk versus human milk – make it unsuitable as an infant formula on its own. Giving just camel milk in its original state will cause malnutrition in your baby (as will giving just milk from coconut, any nut milks, or any plant based milk substitutes).
So what to do? One popular recipe suggests adding cream (from cow’s milk), whey, lactose (that’s the carbohydrate), plus some oils and nutritional yeast to round it up to par for your baby. That’s a great recipe – for kids I’ve never met! If your baby can tolerate all the ingredients in that recipe, most likely, he or she can likely handle breast milk well too, or any of the European or American commercially available organic infant formulas that are made from goat milk.
You can use that camel milk recipe if you don’t mind mixing up your own and don’t like the organic commercial choices, or if your own milk has petered out and no donor milk is available. In that scenario, camel milk as mixed in the recipe above is a great option, and you can expect your baby to thrive with it. If you see funky stools, rashes, or crying, screaming, gas, bloating, or vomiting, then it isn’t a great option.
Not to despair! Even super sensitive babies can try a camel milk formula. It may even be a bonus for them as the immunoglobulins (immune proteins) in camel milk are legend for fighting enteroviruses and protecting immunity.
I work in that plan B zone. The babies I meet in my pediatric nutrition practice usually have severe feeding concerns, and/or are already in a growth regression or even growth failure. They can’t tolerate nutritional yeast because they already have fungal overgrowth in GI tract or an antibody reaction to it. For many of them, even this “healthy” yeast supplement triggers discomfort and pain. They can’t use cream because cream has some casein and whey in it from the cow’s milk it is made from, and they may be allergic or intolerant to those. They can’t use some of the oils in the recipe either because these may trigger their FPIES symptoms, which are terrifying – especially when a baby is vomiting violently until they pass out.
To use camel milk infant formula in these cases, you need to add about 6 grams of carbohydrate and 7 grams of fat for every 8 ounces of formula, while reducing the protein and mineral load. You also may need to remove the whole food sources of B vitamins and iron in the Healthy Home Econonmist’s recipe above, since kids with FPIES don’t do well with many whole foods until their gut/immune interface is improved.
That’s why in the recipe below, for B vitamins, I suggest using a commercially available multi vitamin supplement with iron. The brand chosen below has the least amount of flavors, whole food extracts (which can be poorly tolerated for sensitive babies), or other additives common in children’s liquid supplements. Sometimes, you have to pick your battles. For FPIES or highly allergic babies, it’s not worth the risk of using a whole food option like liver or nutritional yeast. These may be well tolerated later on. Either way, don’t omit the B vitamins, folate, and iron. Your baby needs these and camel milk doesn’t have enough of them.
For 12 (twelve) ounces of a camel milk infant formula that can be tried for sensitive babies or babies with FPIES:
- 8 ounces whole camel milk (available shipped frozen from Desert Farms – request raw if available, flash pasteurized if not)
- 4 ounces purified filtered water
- 2 heaping teaspoons lactose powder
- 1 teaspoon melted grass fed goat ghee or cow’s milk ghee (use goat source for more sensitive babies)
- 1/4 teaspoon (20 drops) DHA fish oil
- 1 teaspoon any tolerated organic oils (olive oil, non GMO sunflower oil)
- 1/4 teaspoon MCT oil
- ~5 drops multivitamin for babies with iron (here’s an example) – don’t exceed 40 drops per day total
Warm camel milk and water gently in a stainless steel pot on low heat. Stir in lactose powder til dissolved. Add ghee, vegetable oils, and MCT oil but not DHA fish oil (heat quickly denatures this oil and makes it taste bad). Stir to melt/blend then transfer to a glass blender and blend on low speed for about 20 seconds. Add vitamin drops and DHA fish oil, and pulse to blend on low speed. If you’d like to add a probiotic, it can be added with vitamin and DHA, but not on stove top (heat kills the bacteria in the probiotic). Transfer to bottles to feed at wrist (warm) temperature.
A formula is a go when your baby can settle comfortably after feeding. Reflux can also often be resolved with the right formula, instead of depending on medicines like Prilosec or Nexium, which reduce your baby’s digestion and ability to absorb things like iron, zinc and B vitamins. If camel milk, goat milk, or products like Alimentum RTF or Nutramigen fail, your baby may feel better with an elemental (amino acid based) formula. I’m happy to work with you to help you do that – make an appointment to get started any time.
Healing leaky gut is one of the most requested tasks in my pediatric nutrition practice. Many parents are surprised to hear me say that it is possible to repair leaky gut in children of all ages.
But what really works? There is a lot of buzz about dietary approaches, probiotics, and supplements, and less good research on leaky gut than we’d like, especially when it comes to infants, toddlers, kids, or teens. However, after twenty years in my clinical pediatric nutrition practice, I can tell you what nutrition supports I’ve seen consistently work, and what strategies often fail.
First, let’s get on the same page about what leaky gut is, and isn’t. It doesn’t mean there are actual ulcers or holes in your child’s intestine that are “leaking”. But it can mean that the intestinal wall has lost some integrity – and has become too permissive about the size of molecules that it lets pass into your bloodstream.
Another way you might hear leaky gut described is “intestinal permeability” or “hyper-permeability” – again, expressing a condition in which the intestine’s normally very selective, tight process for digesting and absorbing food has become, well, loose and sketchy!
Practitioners – myself included – might scrutinize zonulin, stool microbe studies (microbiology culture or PCR DNA methods), inflammatory markers like calprotectin, or immune markers like immunoglobulin A in a stool sample to gauge gut environment. Some doctors may order a lactulose-mannose test in which patients drink a concentrated solution made of those sugars. How these two sugars, which are different sizes, are excreted in urine can give a measure of how permeable the gut is. For more on intestinal permeability tests and their pros and cons, click here. Food allergy and non-IgE food reactions may also be measured, which requires a blood test.
Key To Restoring Leaky Gut Is….
Key to restoring a healthy gut is repairing “tight junctions” – these are the microscopic, traffic-cop structures of your gut. They form a tight seal between cells in the intestinal wall. When these junctions are injured, they break down – and larger-than-ideal molecules cross from the intestine into the bloodstream, triggering all sorts of reactions to stuff that your bloodstream and distant tissues were never meant to see in the first place. These might be anything from polypeptides (over-size fragments of food protein molecules that can masquerade as false hormones, false neurotransmitters, or invading antigens) to toxins, getting access your body from your gut, when they’re not supposed to. This permeability scenario is a catch-22, in that it can easily perpetuate itself, as more injury persists in the gut.
The intestine is our largest immune system interface with the world outside the body – so leaky gut can also wreak immune havoc, from autoimmune problems to frequent infections and illnesses.
What injures the gut? Lotsa stuff – and, making this harder is that leaky gut symptoms are often diffuse and insidious. They can evolve gradually, or with an abrupt onset that never quite resolves. Leaky gut can trigger symptoms in the GI tract of course, but also far from the gut, like headaches or joint aches, stiffness, pain, fatigue, or frequent colds and infections.
image courtesy Jill Carnahan MD
Here Are Usual Suspects for Triggering Leaky Gut
- antibiotic use
- intestinal Candida or other fungal species infections
- undiagnosed food allergy or food sensitivity
- intestinal flu or virus
- food poisoning
- non celiac gluten sensitivity
- poorly tolerated routine vaccinations
- chronic stress
- traumatic brain injury or concussion
- C section birth (baby misses exposure to helpful vaginal flora)
- mom treated with antibiotics in pregnancy or at delivery for any reason
- mastitis (mom needs antibiotics while breastfeeding)
- radiation therapy
- being underweight especially if you’re a baby, child, or teen
Most kids have had at least one of the items on this list. But that last one is key. In itself, underweight can cause intestinal permeability especially in children. You can address all the other triggers, but if your child is underweight – that is, more than fifteen percentile points off his or her expected pattern – your child’s gut can remain “leaky”. There simply isn’t enough raw material and energy on board for that tissue to repair itself, while your child is also trying to grow.
Here’s the rub: Generally, nobody scrutinizes your child’s growth pattern that closely (I will be honest and tell you that I even see gastroenterology work ups overlook this level of detail – and I routinely read my patients’ reports from their GI specialists nationwide). Without defining your child’s actual expected growth pattern – that is, where your child should be today given parental stature, pregnancy history, birth/delivery history, and growth history since birth – then you don’t know if your child is underweight or undernourished. You can learn more about that here.
I meet many children who are underweight. Sometimes it’s caused by families placing kids on diets that are too restrictive. Or some families have become so traumatized by frightening reactions to foods that they just don’t know how or what to feed their children – so, they don’t. Sometimes it’s caused by a well meaning practitioner who didn’t monitor growth and food intake, because they’re focused on lab tests and supplements instead, gave no guidance on what to actually eat, and encouraged a restrictive diet without effective replacements for foods taken out. I have also seen underweight caused by reflux medicines, which can diminish appetite and digestion when used for more than a few weeks or months. When it comes to picky eating, this too will drive growth status down in kids, injuring the gut too via underweight and poor diet.
The flip side of this coin is assessing what your child eats – how much and what – and the only way to discover if your child eats enough non-triggering, nourishing food is to assess a food diary (part of every new patient intake I do), and then align it with the growth assessment. The food your child eats is the lumber that will be used to do the gut repair – so it has to be the right stuff, in the right amount. Supplements (including glutamine, which is a helpful amino acid but not an energy source), herbs, and probiotics don’t provide this raw building material. I meet a lot of kids who have been given a lot of supplements, lab tests, antifungals, special diets, and measures to repair leaky gut. But they’re still struggling – because this essential growth and feeding part gets lost in the shuffle. But put the right feeding plan with the right supplemental supports, and boom – now you’re talking!
Here’s What Works to Repair Leaky Gut In Kids
- Balance gut microbe environment with herbal or prescription agents to directly address fungal burden, Clostridia burden (even commensal strains can be problematic if they far outnumber other helpful strains), Strep or Klebsiella, parasites, protozoans, and whatever comes up on testing. Combine this with probiotic supplementation that matches your child’s stool studies. My preferred tools for assessing this are GI MAP and Doctors Data Stool Microbiology.
- Customize the special diet to your child. Skip dogmatic, one-size-fits-all approaches.
- Give enough protein! Kids may need anywhere from 1 to 2 grams of protein per kilogram bodyweight per day depending on degree of growth impairment.
- Give the right protein; assess first which proteins are triggering with lab studies. Replace trigger proteins with equal or better value non-trigger protein sources, and keep them varied.
- Use free amino acids. Supplementing with amino acid mixes that give all 8 essential amino acids (and not just glutamine) has been a big bonus in my practice for kids who need deep gut repair. Formulas and powders are available. These give the gut direct access to building blocks for new tissue growth and repair. I use anywhere from 5 to 15 or even 30 grams daily of this protein source, depending on a child’s needs or status. Caveat: These won’t work well without an adequate total diet around them to support energy needs.
- Give enough total food including “clean” (non sugary) carbohydrates, which are crucial for growth in children (carbs preserve protein for structure and function, and keep it from being burned for energy) and ample healthy fats and oils. Kids can need 4-6x more calories per pound than adults, depending on age and growth status. Don’t feed them like little adults – give energy-dense, nutrient-rich food.
- Mastic gum, licorice root, zinc carnosine, glutathione, mineral-rich foods or products like Restore are just a tiny sliver of the thousands of products that can aid gut tissue repair. Work with a knowledgeable provider who has used these in children before. Using these tools is a routine part of my practice.
- Correct sleep pattern so your child can sleep deeply and wake rested. Sleep is when our organs are busy with repair and clean up. Hint: Children who are underfed tend to sleep poorly and wake more often.
- Minimize stress in your child’s world. Don’t discuss “leaky gut” with younger kids and don’t frame food or their bodies as problematic. Use positive language and emphasize the power to heal, which we all have.
- Give it time (like, months), be chill, and remember that your child’s body is a miraculous thing with its own innate drive to grow, repair, and heal.
And Now For The Leaky Gut Fails…
- Using rigid diet strategies for growing kids can be too restricting to support growth, gain, and gut repair. Yeast free diet, GAPS, ketogenic diet, AIP, SCD, Paleo, or Body Ecology all have merits (and devotees!), and I use components of all of them in my practice. But in themselves, none of these were created for use in children (except ketogenic diets for seizure control) and can fail when children are already struggling to gain or grow. If you’re not seeing good growth, gain, and progress in behavior or food reactions with one of these strategies within 2- 4 weeks, or if initial improvements lapse quickly, then it probably isn’t right for your child. Customize to your kid instead!
- Needing your child to like any of this, including taking supplements, having blood draws, or accepting different foods. You’re the adult. They’re not going to make it easy for you – that’s a given. Hint: Picky appetites can improve with addressing these three steps – don’t assume your child “won’t eat that”.
- Staying on reflux medicines for months at a time. These will work against your gut healing efforts by keeping pH in the stomach too weak to initiate good protein digestion. They will also cause your child to feel less hungry over time, to eat less, and to become more picky – thus leaving your child underfed and unreplenished for the task of gut repair. Learn more about the downside of reflux medicines here.
- Using glutamine, vitamins, minerals, or lots of supplements before you situate the right feeding strategy for your child. Feeding strategy means knowing what foods to use, how much and which sources of protein, fats, and carbs, and for how long, to support your child’s expected weight and height.
- Being aggressive with fermented foods, probiotics, or too much Saccharomyces boulardii. These can backfire if used for too long or at too high a dosage, and may even start to create their own dysbiosis or discomfort.
- Leaving fungal, parasite, SIBO or SIFO, or other dysbiosis untreated or under-treated. This can interrupt appetite, digestion, and stooling and keep tight junctions from sealing up.
- Giving up after 2-4 weeks. This is a restore and repair effort that may take months, depending on how long your child’s gut has been in the weeds.
Want help? This is a lot! Let me sort the best options for your child. Contact me today to set up a time to work with me remotely or in person. Or, peruse my options for books and on-line-course support.
I’m often asked if ketogenic diets are good for kids. Parents are trying this diet and having great results – why not put the whole family on a ketogenic diet?
It doesn’t take much searching to learn that ketogenic diets have been vetted for nearly a century, when they were first noted for their ability to control seizures. Even conventional training for dietitians has included training in ketogenic diets for decades – they’re not new.
The new part is using them for weight loss, fitness, and all sorts of chronic conditions, from cancer and autoimmune problems to Alzheimer’s, multiple sclerosis, or autism. You’ve probably seen experts – from Mark Hyman MD to David Perlmutter – singing the praises of ketogenic diets. But what about your kids? And, what about using a ketogenic diet for kids with autism?
Ketogenic diets use high amounts of fats and oils, lots of protein, and very little carbohydrate. Typically about 70% of all the food you eat on a ketogenic diet will come from fats and oils, with only about 5% coming from carbohydrates. By contrast, kids usually eat anywhere from 50-70% of their total diets as carbs, with 20-40% as fats – so this is a big switch.
Research is mounting to show that eating this way changes the bacteria that grow in your gut. By now, you’ve probably heard about how deeply we rely on gut bacteria for overall health. Gut bacteria are essential to our well being, in that they help us digest and absorb the nutrients we need. They also cut inflammation and protect us from invading pathogens – that is, if your gut bacteria profile is healthy.
This is critical in early infancy too, to avoid conditions like allergies and asthma later on. And gut bacteria play important roles in other conditions that have been regarded as exclusively psychiatric or neurological for decades, including autism – but for years, I have helped families reverse behavior and developmental concerns in their kids by restoring a healthy gut biome. Now research is finally mounting to show that this is indeed possible!
If you have a lousy gut bacteria profile (which you can acquire by eating a junky diet, or using antibiotics, reflux medicines, and steroid anti-inflammatories), chronic and systemic problems are likely going to ensue. It’s popping up all over the academic literature landscape, and I’ve seen it happen before my eyes in practice for years: Nasty gut flora = nasty kids, nasty poop, nasty behavior, poor eating habits, and chronic health problems!
Anytime you change your diet, you will change the bacteria in your gut, in about 2-3 weeks. Ketogenic diets change gut bacteria too, and it is through these changes that this diet can support renewed health. Ketogenic diets also change our body’s primary fuel from glucose, which is obtained by eating carbs, to ketones, which are obtained by eating mostly fats and oils. The brain, and all our organs and tissues, can run well on ketones. When the body is using ketones all the time, this is called being “in ketosis”, a goal that is closely monitored for people who use ketogenic diets to control seizures. Even tiny amounts of carbohydrate can trigger a seizure for some people with epilepsy. Being in ketosis is when seizure control can happen best, for people who fail on seizure medications.
But ketogenic diets for kids may have a cost. They may not grow as tall as they would if eating a diet with more carbohydrate in it. This was noted in this study in children using ketogenic diets. The children’s progress for linear growth (that is, height or stature) slowed down after 15 months on the diet.
This may be partly due to changes bone density. Effects on bone development were closely scrutinized in this study, which found reduced bone density with ketogenic diets for kids.
Effects like stunting from ketogenic diets for kids have been observed for many decades, and I have witnessed this myself in my pediatric nutrition practice. Kids who come to me already on a ketogenic diet follow what occurred in this study, that also saw slowed growth for height and weight in children using ketogenic diets. And in this study, the number of children who fell below tenth percentile for height more than doubled, from ten to twenty-three children, while using ketogenic diet. They also had more than expected kidney stones and bone fractures. Children also may gain weight more slowly on ketogenic diets, impairing their growth pattern for both weight and height.
Slowed growth is not just a physical issue. It can have cognitive, functional and behavioral impacts too – and this another often-seen issue in my pediatric nutrition care practice. Ketogenic diets for kids may thus create unwanted cognitive effects, as described in this study on developing rats. In my practice, one of the most common findings for school children with ADHD/ADD is that they are underfed – ironically, often because they have been using a stimulant medicine that suppresses appetite. Eating poorly, they fall in and out of ketosis during the school day and disintegrate behaviorally for focus. Their food intakes need improvement, but being in ketosis does not seem consistently helpful.
These impacts may not be a concern for adults on ketogenic diets. This very small study of only three individuals did not find changes in bone density after five years on a ketogenic diet. This study of sixty-five adults saw reduced bone density in groups using either very low carb or calorie restricted diets for weight loss, but it’s unclear if the subjects sustained ketosis or not, or if bone density dropped simply because subjects weighed less at the end of the trial.
The Up-Side of Carbs
Carbs have been demonized for sure, and not without cause. I have seen thousands of food diaries over my years in practice for infants, toddlers, kids and teens (thank you to all those parents who filled those out with dispassionate honesty!). Without question, many kids I encounter come in with carb-heavy, low quality diets that rely too much on processed grains, sugary yogurt, juices, or starchy crackers and snacks. Not good.
But there is an up-side when eat kids about a third to half their calories from clean carbs. Kids are growing. Adults aren’t. When we’re growing, carbohydrates from food we eat spare the protein and fat we eat, so that they can be used for other critical tasks – both metabolic and structural – that adults simply don’t have because they’re not growing.
A child needs a lot more energy per pound than an adult. Depending on a child’s age or growth status, they can need as much as five times more calories per pound than an adult! This could be the same as you or I eating ten thousand calories every day, just to maintain a normal healthy weight (imagine what would happen!). Strangely, even when kids use calorically adequate ketogenic diets, they can still experience stunting.
This might be related to the fact that kids’ brains use about double the amount of energy every day compared to an adult’s brain, in terms of the percentage of energy derived from the food you eat. This is true until about age four, when head growth slows down relative to the rest of the body.
Long short, adults aren’t growing, and thus don’t need a sparing effect from carbohydrates.
The big caveat here is that kids need clean carbs. When kids eat healthy, clean carb sources with good protein and ample varied fats, they grow well, and behave, sleep, and learn well too – I’ve seen this hundreds of times. “Clean carbs” are unprocessed, no-added-sugar, whole foods. Think vegetables, legumes, and tubers – parsnip, squashes (butternut, acorn, spaghetti squash, zucchini, pattypan), asparagus, cruciferous vegetables like Brussels sprouts, broccoli, or cauliflower, carrot, potato or sweet potato, greens, lentils, chick pea or beans, green and wax beans, taro, or manioc are all carbs to have on your menu rotation. They provide pre-biotics for your gut bacteria to work with for healthy fermentation in the gut and nutrient production, not to mention their bonus of minerals. Fresh unsugared fruit (not fruit juices) is helpful too. When it comes to grains, sprouted grains will be more digestible, but grains are by no means absolutely necessary in your child’s diet.
One not so great carb is yogurt – because yogurts for kids are generally loaded with added sugar or sugary fruit. Most yogurts on store shelves have far more sugar in them than fat or protein, so if your kid chugs drinkable yogurt tubes or even a non-dairy yogurt cup daily, switch to a no-added sugar option and use a drop or two of organic stevia to sweeten it if need be.
But Babies Are Born In Ketosis! So…Doesn’t That Prove Ketogenic Diets Are Good For Kids?
When babies are born, of course they’re in ketosis – they’re not eating anything yet at all, and need a fuel to carry them through what may be hours of labor. Ketones work great. A young baby (a month old or less) relies often on ketones to fuel the brain for its first few weeks. Ketones are preferentially allowed into the delicate new brain over glucose as an energy source in that first month too. This is when “early milk” or colostrum has more than twice as much fat in it than it does carbs. Does that mean ketogenic feeding is the next rage for babies and toddlers? I don’t see it. By the end of the first month, breast milk nutrient ratios shift, so that it’s nearly 40% carbohydrate, and this doesn’t change much even for moms eating ketogenic diets. In other words, after that early milk, we evolved to give our babies 30-40% of their calories as carbs in the first year; our bodies will preserve this ratio in our milk no matter what we eat.
For infants or kids with seizure disorders, ketogenic diets can be miraculous. They are definitely worth trying and definitely warrant professional guidance. They may work because they do change gut bacteria, and eating any carbs – even clean carbs – above 20-60 grams/day (which is quite low) may trigger relapse of seizures. Follow your care team’s advice if this is your situation.
Ketogenic diets that are poorly monitored can be dangerous. I don’t recommend launching one for kids without professional guidance. If you have, watch for these warning signs of hyperketosis: Rapid, panting breathing; rapid heart rate; facial flushing; irritability; vomiting; or unusual lethargy. If you see those signs, call your doctor right away or go to your nearest emergency room.
For kids with autism or other conditions, there are options to tailor ketogenic diets to each child so that functioning improves dramatically, without compromising growth, bone health, or kidney health. This is one of my practice offerings, so contact me if you need help. And if you’re still laughing about that long list of veggies that your kid would never eat, let’s get in touch to work on that. Changing that gut bacteria profile can change your kids’ palate and appetite!
Is your child underweight? Your doctor would have told you, right?
Maybe not. In fact, I am often the first person to capture this finding in a toddler, child or teen who has seen multiple providers, from the pediatrician to gastroenterologist to allergist and so on. But this is really important for kids. Why? Because once kids slide into growth impairments, it throws a lot of other stuff off kilter for them. One, their immune systems don’t work as well. They can get sick more often, stay sick longer, and have more complications from infections than kids in healthy status. Two, they struggle more to behave, learn, focus, or sleep, and will often experience more anxiety, less self regulation, and more mood swings. This can happen even with mild or moderate growth impairments. In other words, kids don’t have to be severely underweight for this stuff to go wrong. When kids finally hit bottom with that failure to thrive (FTT) status, this will create a leaky gut – something many parents ask me about – because there aren’t enough nutrients and energy from food for the child’s gut wall to maintain its integrity. And, the younger a child is, the more vulnerable they are, when dropping off channel.
Pediatric providers generally won’t intervene on or even mention a lagging growth pattern unless your child is really, really underweight, as in – heading for the very bottom of the growth chart. Why not? There are several reasons why this can be true:
- Your insurance may not pay your doctor to intervene on any growth impairment other than failure to thrive (FTT), a severe and entrenched problem in which a child has fallen to below the fifth percentile for weight for age.
- Your doctor may not know that dropping just fifteen percentile points off expected growth pattern, for either weight or stature, actually means your child is underweight or undernourished.
- Your pediatrician may not know how to calculate your child’s ideal body weight, expected weight, or expected height, or doesn’t have time to do it.
- Your doctor doesn’t have time to scrutinize, integrate and explain all the growth data in that brief fifteen minute visit, including all the things that impact growth, from your kids’ food intakes to energy level to genetics.
- Your doctor isn’t sure how to help you fix the problem, or why it’s happening in the first place, if they notice it.
Because I work with kids with problems like allergy, autism, FPIES, inflammatory bowel conditions including Crohn’s disease, or all sorts of circumstances in which they can’t eat regular diets, it’s common for me to find that a child is indeed underweight. Many parents who contact me have placed their kids on special diets on their own, and don’t realize their kids are underfed and malnourished, even with all the best efforts at feeding well. But it can be a relief to know exactly what and how much food your child needs to grow, feel, and function better.
Usually, parents are downright surprised at what a difference something as simple as the right food intake makes for their kids. This quote is straight out of clinic today from a mom regarding her fifth grader, who had severe attention and focus issues for which he’d used medication, difficulty with independently toileting (constipation, stool accidents), frequent infections, and felt unhappy or frustrated often:
“Looks super healthy, I’ve never seen him this healthy. He seems more like a regular kid. He is thriving. He is growing like a weed. He is happy.”
This boy is off stimulant medication, using the bathroom independently and not having accidents, and has not had any infections for months, for the first time in his life.
What would your pediatrician do for these problems?
He would do what had been done for this child, and failed: Give methylphenidate (stimulants like Focalin, Ritalin, etc) for inattention and hyperactivity; Miralax for the constipation; antibiotics for the infections; and a “he seems fine” shrug for the moderate drop off of expected weight for age.
Nutrition care is not a replacement for medical care – and vice versa: Medical care is not nutrition care. They do different things, and require different skill sets. Strong nutrition in kids makes them healthy; prescription drugs mostly avert acute problems. Neither replaces the other, both are important for kids – but, unfortunately for kids all across the US, nutrition is not a big player in pediatrics nowadays.
Is your child underweight? Is it impacting their health? It’s easy to find out. There are well established criteria for determining things like expected growth pattern for a child, and how to restore it if lost. There are many tools at my disposal too, to sort out what foods would best serve your child, what foods you might really need to avoid, and what foods you really may not have to worry about. If you’re not sure, schedule an appointment and we can just find out!
There has been buzz for years now about camel milk, and its purported benefits for autism, Crohn’s disease, allergies, feeding problems and more.
I’ve been slow to embrace this possibility, because all mammalian milk (including human breast milk) contains milk protein – that is, casein – and casein can become problematic for many reasons. Casein structure varies a bit from species to species or even across breeds of animals in the same species (as described in the A1 versus A2 milk conversation). This is what can make goat milk or sheep’s cheese more tolerable than cow’s milk for some kids. But all these milks – including human breast milk – can make a neuroactive protein fragment called casomorphin.
I’ve needed a good explanation for why this is not a problem with camel milk, and I found it. Here’s the story.
Camel milk truly is different from milks that we make, or cow, goat, or sheep milk too. Here is a detailed comparison of what’s in camel milk versus human breast milk. But one thing all mammalian milks have in them is a protein called casein, which is often allergenic. Even as casein varies across species and can be easier to tolerate depending on the animal it comes from, generally, all casein can turn into a littler protein chunk called casomorphin. This can be a big trouble maker.
Casomorphin is great for babies in their first year. It is correlated with optimal psychomotor skills and muscle tone. But it can wear out its welcome, when a child’s intestine doesn’t acquire the skill to digest it thoroughly, past the age of 12-14 months. I routinely see this in my practice, in milk-addicted kids: Constipation, delayed language or aphasia (non-verbal), extreme picky eating, tantrums, ADD/ADHD, disrupted sleep, and behavior problems can come from a diet that uses mostly casein as a protein source. When those signs are active, kids are usually turning that casein into casomorphin, which is potently addicting, making for an extremely picky appetite, causing constipation and terrible behavior. If this is your kid, buy this e book. You’re welcome. It will save you a lot of time, pain and agony in feeding clinics, GI doctor’s offices, or in surgery avoided for a G-tube.
Casomorphin is easy to measure in urine. I have found it in the urine of older toddlers still breastfeeding, who strictly avoid dairy foods in their diets otherwise, and whose mothers strictly avoid dairy too – proving that the casomorphin indeed can come from weak digestion of the protein in breast milk. In these cases, weaning to non-dairy proteins in food did the trick.
Casomorphin is a “powerful opioid, more powerful than morphine itself“. It blunts sensation, and can delay potty training; it also prevents a process called synaptic or neural pruning, in which the brain adjusts its growth to accommodate new developmental phases. Without pruning, kids’ heads grow disproportionately large, and development – especially for language and social reciprocity – can stall. It’s common for me to see this phenomenon in children with autism who have had diets liberally inclusive of dairy protein, whether it’s from milk, cheese, yogurt, ice cream or whatever – all these dairy products contain casein. Gluten and soy proteins can form morphine-like neuroactive peptides too, in the context of weak digestion. These have been linked to autism features, for many years now. This is why kids with autism may begin to speak, function, behave and sleep better by removing wheat, dairy and soy foods entirely – stop eating opiate like neuropeptides, and their brains begin to work again.
What about camel milk? It turns out that the casein in camel milk is different enough in its structure to not create casomorphin, the opiate-like neuropeptide I’m talking about – while at the same time, its other components are also unusual – making for some extra healing benefits. It doesn’t have the same casein structure that cow’s milk has, and thus can’t create casomorphins that have brain-damaging potential, as is seen in autism. Camel milk lacks the beta-lactoglobulin found in cow milk; that, plus its different casein structure, means that the two most allergenic proteins in cow milk are absent from camel milk. The whey proteins of camel milk are different too, making them less allergenic. And camel milk has higher amounts of the immune protecting proteins lactoferrin and immunoglobulin than cow milk – though some dispute that the difference is enough to explain the medicinal benefits. But because camel immunoglobulin molecules are tinier than those in cow or human milk, and because they appear to be more potent in completely neutralizing an infectious agent, they can more easily target and disable viruses or bacteria in the gut. Traditionally, one of its many uses was for clearing rotavirus – something your child was probably vaccinated for, as rotavirus vaccines have been included in the CDC schedule since 2008 (look for RotaTeq on your child’s vaccine record). Who knew all they may have needed was camel milk?
Little data exist for its healing properties, but the little that is out there is compelling. A controlled clinical trial in fourteen children with autism who drank pasteurized camel milk instead of cow’s milk for eight weeks “revealed a decreased hyperactivity, increased alertness, grasping power and curiosity, better social interaction and many parents commented on the newly expressed effort of their children to listen and obey instructions.” The children also had daily bowel movements instead of being constipated, and got sick less often. Urine samples showed no elevation of beta casomorphin-7, the trouble-maker molecule in question for milk drinkers. In a larger, double blind, randomized trial of 65 kids with autism, profound improvements were once again noted, from just two weeks of camel milk consumption. And yet another blinded and randomized trial in 60 children with autism found that camel milk significantly reduced oxidative stress (a well documented feature of autism that underlies behavior problems, GI symptoms and more) while it gave a boost to the kids’ glutathione levels, which is a healthy body’s top protector against toxins. Glutathione is legendary for being depleted in kids with autism, and has been the target of much investigation, since correcting it may diminish features of autism. Glutathione is also a key to reducing symptoms of Crohns disease; a healthy gut wall is rich in this antioxidant, while a sick one is depleted of it.
Another obscure report lauds camel milk as a wound healer in diabetes; other findings suggest that camel milk has enough insulin-like peptides in it to effectively lower blood sugar. Meanwhile, here’s that nasty casomophin from cow milk again, possibly triggering diabetes. I found no trials specific to food protein induced enterocolitis syndrome (FPIES), but did find one that plainly showed that most kids with milk protein intolerance handle camel milk just fine, and that skin prick testing worked to screen for this option.
While controlled trials are few, anecdotes are plentiful on the web, describing remarkable improvements in children with autism who switched to camel milk. Here is a collection of some research on camel milk nutrition and how it can work for kids with other-milk allergy.
This all sounded good enough for me to spring for $275 worth of frozen camel milk (it doesn’t come cheap). I’m going to try this out. My son has a long history of inflammatory bowel symptoms and struggles to gain weight; I have a long history of autoimmune problems and am dependent on infused human immunoglobulin therapy to, well, pretty much stay alive. If anyone had good reason to give camel milk a try, I do. And there are a few hundred kids in my case load who might benefit. I like to have first hand experience with whatever I recommend to my families.
The only dromedary dairy in my region was cryptic and unfriendly when I reached out; they wouldn’t let me visit or purchase in person, so I passed. Besides, knowing that the entire Front Range of Colorado is under siege from cancer causing fracking contaminants in air and water, I felt it would be better to buy a product from somewhere else. Camel milk isn’t sold in stores near me as far as I could find, so I went with the one outfit that seemed well equipped to produce, sell, and ship milk reliably: Desert Farms. Stay tuned to hear how this goes! Should be interesting. As a recipient of immunoglobulin therapy, I am monitored closely every three weeks for my immune status, so I will be tracking what happens. Let me know how camel milk worked for you, if your family tried it!