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What If Labs Are “Normal”, But Your Child Still Feels Awful?

What If Labs Are “Normal”, But Your Child Still Feels Awful?

Has anyone on your child’s care team done lab tests, only to tell you they’re all “normal” and there is nothing more to do? Or worse, you’re sent to a specialist for more tests and invasive procedures, when you still don’t understand what is going on?

This is such a common story in my pediatric nutrition practice that I had to address it. The truth is that any lab test result has two interpretations: Lab range, and functional range. Anyone, including babies and kids, can have test results that fall within the lab reference range (considered “normal”), when they are in fact teetering on health disasters. Functional range means your lab test results fall into a more narrow range, and this is where you actually feel good. You’re not just not sick, you’re well!

If your pediatrician is using only lab range to interpret your child’s results, then a lot of opportunity for well-being is missed. And, you may end up doing more invasive and useless diagnostics, when improving these initial findings is all that your child might need.

Establishing what is considered “normal” ranges for lab test results is difficult to do. Groups of individuals who have no known health problems are tested, and a range is created from their findings, for each lab test that exists. These ranges can be wide. But functional lab test results fall smack in the middle of the lab reference range. The lab range is wider than this, and may include findings for people who are not so healthy. This is why it’s good to look closely at your child’s findings and ask questions.

Here’s what to do:

  1. Always get a copy of your child’s labs, after any visit where your doctor presents them, including emergency room visits. Keep these in an organized file.
  2. Use your doctor’s secure on line portal (if they have one) to view your child’s labs. Download these and save them as pdfs if you like, so you can carry these into other provider visits with you, and get second opinions.
  3. Scrutinize your child’s lab test results yourself. If you notice results that are close to being out of range, ask your doctor about this.
  4. Don’t assume your primary care doctor or pediatrician always or immediately sees lab test findings done in an emergency room visit, or at a specialist visit. Always maintain your own files of these and share other providers’ test results with your pediatrician or primary care provider.

Some typical examples of  “lab range” problems from my practice…

  • Gluten sensitivity may bet the most frequently missed diagnosis I see. Many doctors run celiac panels, which can be normal, even when a child has a gluten reaction. The problem here is that many celiac panels do not check for gluten reactions – they only check for celiac serology. It’s possible to have debilitating reactions to gluten, without having celiac disease. This is called non-celiac gluten sensitivity and it can really wreck your kid! Definitely get a second opinion if your child continues to grow poorly, have stomachaches or headaches, or experiences ongoing gut or even psychiatric symptoms.
  • Iron and Anemia Screening: You may have seen a normal hemoglobin and hematocrit at your child’s annual physical, but this can miss other problems concerning iron. The hemoglobin and hematocrit test is done with a finger prick drop of blood. This will only fall out of lab range if your child has entrenched anemia. Read this blog on iron screening to learn what to do next – prevent complications from marginal iron status that don’t show up with the fingerstick test.
  • Ferritin (the storage protein for iron) has a very wide lab range, and labs vary on how they report it. Some labs report a ferritin level as low as 10 as normal; others say it’s okay for it to be as high as 400. Either way, ferritin is so important for your child’s immune function, learning, behavior, sleep and more that more investigating is worthwhile if this lab finding is not somewhere between 40-85.
  • White blood cells (WBC) fight infection, and the lab range may sound small: Anywhere from 4.0 to 14.0 for kids is considered “normal”. But if your child’s WBC count jumps from its usual level of 5 or 6, to say 11 or 12, then it’s possible your child is fighting a new infection – even though it’s still “in range”. Or if it always hovers at the low end, say 3.8 to 4.0, then your child may have an undetected chronic infection that keeps him tired, cranky, or inattentive. Is your child having any fevers, intermittent malaise, frequent colds and bugs, tired all the time, unable to shake off a cold or virus? Go back to your doc and ask about it. By scrutinizing the blood count further, your doctor can discern if your child is fighting a bacterial infection, a virus, or struggling with a moldy environment, and may be able to help you more.
  • Vitamin B12 can be a red herring if it your child’s serum level is reported above range. This may mean B12 is hanging out in serum instead of getting into red blood cells, where it is needed, so those cells can function normally with normal size and shape. Further scrutiny of a complete blood count will show if B12 is needed, as will a test called methylmalonic acid. Serum B12 level alone can’t give the whole picture. Simple changes in nutrition protocols can fix this.
  • Lyme disease antibody may report as a false negative if your child got exposed to this infection long ago and you didn’t know. If Lyme disease is at all suspected, ask your doctor to be as thorough as possible. Do both the Lyme antibody test, as well as all the “reflex bands” and a co-infection panel. Undiagnosed, old Lyme infections can impair immune response to other infections, so the co-infection screening is important.
  • Blood tests for heavy metals are not terribly useful. Blood tests can “see” recent or active exposures to heavy metals, but won’t show you about past or old exposures. If your child’s mercury or arsenic screening came back ok, this doesn’t show whether or not those metals are hiding out in places they really like – like kidney, brain, or nerve tissue. Mercury, lead, arsenic and other heavy metals like to avoid watery spaces (like blood) and migrate to fatty tissues, where they tend to stay put. If you really want to know about heavy metals in your child, some other tools are necessary.

These are just a few examples of how your doctor might miss opportunities to really help your kids feel good. If you have questions, always ask. I maintain continuing education credits in functional blood chemistry, and enjoy helping families with using nutrition supports to help kids feel really well. Make an appointment with me today if you need extra help!

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Top Ten Nutrition Fails That Trigger ADHD

adhd-medication-by-state_cdcNo matter where you look, ADHD is everywhere. Can nutrition help? Kids as young as two years old routinely receive stimulant medication for it. According to CDC data, kids on Medicaid – that is, kids in poorer families – are more than twice as likely to get medication for ADHD than kids whose families have employer-sponsored insurance.

That’s no coincidence. Families in poverty eat poorly. They may live in food deserts, where fresh nutritious food is simply not available. Or, they may have no car (how do you get a week’s worth of food home without a car?), or no kitchen. Plainly, these are the kids whose brains will suffer most from outright malnutrition.

But what about families with means? With cars, kitchens, Whole Foods markets, and health insurance? Why are so many of their kids presenting with ADHD symptoms too?

Because: Your child can be eating well, and even eating a lot, and still have one or more of these sure-fire nutrition fails that can trigger ADHD features. Leave any of these unaddressed, and it can be an uphill climb, whether you decide to medicate or not.

1 – Fungal body burden and gut dysbiosis – Especially for kids with big appetites for sweets, starchy processed foods, lots of bread, pasta, or dairy food.. but little else (hates veggies, hates proteins), this is a biggie. Optimize your child’s gut biome, and you will be amazed at the changes you will see in behavior, mood, attention, distractibility, and focus. “Fungal load” isn’t considered problematic in mainstream pediatrics, but it takes center stage in functional nutrition and functional medicine practice. Unless a child has visible thrush coming out of a body orifice, obvious ringworm style rashes, or other visible fungal skin manifestations, you’re probably not going to get traction on this one at the pediatrician’s office (but you will get an Adderall prescription). A functional stool culture to screen for fungal load and check levels of adequate beneficial flora is a start, and there are many other lab tests to define this piece. Depending on findings, I will choose a combination of herbal supports, probiotics, and foods to correct this. Correcting this piece can balance blood sugar swings your child may experience throughout the day, as well as eradicate irritating toxic by-products of a fungal-heavy biome. The result is a calmer, happier, more focused kid.

2 – Weak iron status – Iron is deal breaker for attention, focus, mood, sleep pattern, and appetite regulation. We need it to oxygenate the brain of course, but we also need it to create and balance neurotransmitters for learning. Kids don’t have to be anemic for weak iron to create or worsen ADHD features. Kids who have anemia (more common than you might think) are easy to spot. They are tired, with pale skin or dark circles under their eyes. They sleep more and are visibly fatigued. They get sick more often, and stay sick longer. Your pediatrician is likely to pick up on this obvious problem with a simple finger prick blood test for hemoglobin and hematocrit. These only fall below normal levels when a child is well entrenched in iron-deficient anemia.

But there is a big grey zone between anemia and solid, healthy iron status.  It’s called pre-anemia. That’s where kids may not look anemic, but will have distractibility, irritable moods, impulsivity, insomnia or broken restless sleep, and poor school performance, especially for math tasks. They may have bounds of energy part of the day, then get flat tires later on. More detailed testing than your pediatrician’s finger stick for hemoglobin and hematocrit are needed to sort this out. Learn more about the iron-ADHD connection here.

3 – Fish oils:  You’re Doing It Wrong – Tomes have been written about what fish oils, and specifically omega three fatty acids, do for the brain, and about how our diets have changed over the last half century to deprive us of them. Fish oil supplements are widely available to help address this, but the trick is in the dosage and in the form. Many families I meet in my office use too low a dose, or use the wrong combination of oils for their child’s needs.

For kids with inattentive, incomplete, or stilted effort when it comes to writing, reading, and visual tracking, emphasize DHA omega 3 fatty acids, and give 400 to 800 mg daily; more may benefit in some cases. Supplements that only give 50-200 mg DHA are of little value for ADHD or dyslexia. Nordic Berries DHA might be fine for kids who don’t have attention or learning problems, but they don’t come close to providing a therapeutic amount of DHA for kids with ADHD. For kids with impulsivity, emphasize EPA omega 3 fatty acids, and give 2000-4000 mg daily (two to four grams).

Liquids often work better than pills here; pills are large and often too numerous to take, to meet a relevant dose. Many products combine DHA and EPA omega three fatty acids into one dose. My preferred products (based on kids’  acceptability, dose, ease of use, and palatability) are Barlean’s Ultra High Key Lime Omega Swirl or Pharmax Finest Pure Fish Oil, but there are many others. Avoid sugary gummy chewable versions of DHA supplements, which tend to have more sugar than fish oil in them, and don’t do much good.

Note: Cod liver oil is a different animal altogether, and doesn’t have adequate DHA and EPA in itself to crack ADHD symptoms, unless you begin using doses of a tablespoon or more daily – and for some kids, this is too much because of the high vitamin A content in it. It is fine to combine cod liver oil with other fish oils and it is a great immune boost in itself.

4 – Weak protein – There are many ways protein can go wrong. When it does, it means the brain can’t get the amino acids it needs to build and balance things like dopamine. Amino acids come from protein we eat. Whether it’s too little total protein eaten daily, too much of just one kind of protein (such as, your kid only eats dairy protein), eating inflammatory trigger proteins (undetected food sensitivities or allergies), or protein that is poorly digested or absorbed, kids who don’t get the right balance of amino acids into their brains are going to have “behavior” problems that can manifest as ADHD.

Amino acids are the building blocks of things like dopamine, GABA, serotonin, epinephrine, and all our neurotransmitters. Kids can look strong as an ox, grow well, and have more energy than you can handle – but may still have poor amino acid availability in the brain to build that focus chemistry. Or, they can eat a varied diet, but have chronic inflammation from low grade, undetected food protein sensitivities or allergies. Another problem is a pattern of constipation – always suspect for poor protein digestion and absorption.

There are many ways to sort out what your child’s protein story is, and many ways to fix it once you know what it is. Some kids just need diet changes; some need protein supplements; others need individual amino acids given as blends or as singles, such as tyrosine or carnosine. Still others may only need to improve a constipation pattern with gut biome balancing. Again, you may be astonished to see how easy it is to lessen ADHD features with targeted protein corrections.

5 – Too little food all day, every day – So simple, it’s exasperating. And many of you are probably saying, “…but my child can’t eat during the day at school, he’s too distracted / disorganized!” It is a catch-22, but once it is solved, kids do so much better. There are solutions that can get to the cause of this so that kids can pause and eat better, and they are worth the effort; there is no way a growing child can function smoothly from early in the morning to late afternoon, without eating.

While I work on helping kids’ appetites from the inside out, many of my clients work with school administrators on creating on a small lunch bunch so their kids can eat with a few peers in a quieter spot (a common accommodation in Individual Education Plans or IEPs); or, pack easy-to-swallow, high density liquid nutrition for lunch instead of a bento of items that require some disassembly, utensils, or organization. A formula called Neocate Splash has been helpful for many kids in my practice. Yes, it has some “ick” ingredients, but this product has permitted many of my kid clients to make it through a school year happier and more functional than if they had not had it at lunch – especially those with multiple food sensitivities. Another option is Orgain, an organic version of drinks like Pediasure which is available with or without dairy or soy protein. Orgain is in many supermarkets as well as Costco.

A simple finger food or two with a high-octane liquid lunch like this is better than zero food or a few raw vegetables and cheese. Consider deli meat wrapped around fruit; something to dip in hummus or pesto (crisp bell pepper wedges, crackers with seeds or sprouted grains); jerky or even bacon; or snack bars or bites rich in healthy carbs and fats, like Lara Bites or Lara Bars. Living here in Boulder, Colorado, it seems I see a new organic, kid friendly, hypoallergenic snack product every week in our local stores. If your local stores don’t stock healthy nutrient dense bars or snacks, shop on line – the options are endless, and impressive.

6 – Undiagnosed food sensitivities – These reactions, which are different from food allergy reactions, will definitely niggle your kids’ brain, and keep the distractibility flowing – along with dysgraphia, impulsivity, and slower processing speed. If you’ve done food allergy testing via skin prick or blood draw, you’re not done. Consider an ELISA IgG food antibody panel to find the full story. Cross-reactivity can occur between IgG food reactions and brain tissue – lab tests are also available to scrutinize this too, if helpful. Even if you’ve tried elimination trials, do the test to see what is really going on.

7 – Too few carb calories – We love to demonize carbohydrates these days, but truth is, kids really need them. A balance of healthy carbs in kids’ diets fuels progress on their weight-for-age growth pattern. It also protects protein from being used up for energy during the day – important, because we need that protein to get to the brain for functional focus chemistry. When there are enough carb energy sources around, protein is spared for growth and structure – so your kids can progress on their height-for-age growth pattern. Without carbs, even if your child eats a lot of protein, linear growth (height) can be stunted. Don’t limit your kids for reasonable carbs. Allow hefty ones during the school day with some good protein and fats – pumpkin breads, custard cups, sweet potato chips with guacamole, Paleo treats like Hail Merry Miracle Tarts or Merry Bites, Chia Pods, quinoa or cous cous salads with chopped cooked green or wax beans, olives, and hemp seeds – the options are plentiful!

8 – Not eating organic – Yup, it’s more expensive. But even the American Academy of Pediatrics is on board with this one. If you missed it, a clear association was found between ADHD and agricultural pesticides in urine in children. Per standard operating procedure, the AAP stated that more research is needed to see if this is causal. Wanna wait for that? Your kid will be 25 years old. Play it safe and smart, and splurge on organic when you can; grow your own; get some chickens or barter with neighbors who did; visit your local farmer’s market. Your kids really are what they eat!

9 – Untreated methylation impairments – You may have heard of nutrigenomics, the practice of integrating your genome with food and nutrients. Many things turn genes on and off, from toxins to nutrients. We have genes for everything, from what color eyes we have, to how vitamin D attaches to cells, to how efficiently we make dopamine, yes dopamine – the target neurotransmitter of many drugs for attention and focus. Dopamine depends on a process called methylation, and methylation gene mutations are quite common. They are easy to screen for (with a cheek swab or blood test for some of your DNA) and straightforward to support with methylated forms of certain nutrients. This can improve attention, focus, anxiety, and depression – drug and side effect free.

10 – Thinking any one of these things in itself will fix ADHD –  Your kid’s brain is like an engine – lots of moving parts, in terms of what is needed for functional focus biochemistry. Sure, you can change the oil, but what if the timing belt needs adjusting, or the fuel pump is failing? Don’t expect foods and supplements to work like drugs. If you tried just one nutrition approach and it was dismal, revisit the options mentioned here. Though it takes extra work to assess and coordinate all these components, the bonus is your kid will likely feel happier and healthier over all, without a drug dependency that can last well into young adulthood. Long term use of stimulant medications for ADHD has been shown to make no impact at all for academic improvement in boys or girls, and to increase depression in girls, according to this study. But building strong foundational nutrition will serve your kids for years to come.

Need help? Got questions? Set up an appointment via my calendar here. I can’t give treatment advice for your child in this forum, but would be happy to work with you in my pediatric nutrition practice. I look forward to hearing from you!

Why GAPS Can Fail Your Child

Why GAPS Can Fail Your Child

Yup, GAPS can fail. And it’s probably not your fault.

Gut and Psychology Syndrome Diet has a lot success stories… But what about the kids who fail on GAPS?

I have met a lot of those kids. After GAPS has just plain not worked (or worse – traumatized the family and injured the child, which can unfortunately happen) – I’m often the next stop.

These are smart people who followed the GAPS protocol carefully, and engaged lots of on line support; some worked with GAPS certified practitioners.  But still: Fail. Their kids withered on bone broth; vomited or bled in stool on probiotic foods; and had bloating, rashes, and irritable stools with egg yolks, avocados, and nut butters. Their parents pressed on, for months or even longer; some moms have described to me the intense pressure they felt to stay with this protocol, and the deep sense of failure they internalized about it not working.

Okay, here’s the thing: There is no one diet for everyone. There never is. All children with autism, FPIES, or gut issues do not benefit from or need GAPS. I have met many who failed on it. GAPS works well for some. It fails for others. If it isn’t going well, odds are it’s not your fault. Your child just needs something different.

So, what can go wrong? Why not just try it?

Besides the possibility of wasting a lot of money and effort preparing scratch foods that may be wrong for your child, you’re going to waste time too – which some children simply can’t afford. The younger they are, and the more undernourished they are to start, the harder this can be on a child, if it isn’t the right measure.

And a mom’ s worry is no small thing. Chronic, strong apprehension and anxiety about anything is hard on parents. It changes your chemistry, and ups your cortisol. Sensitive children will sense your strain, and this will strain them. If you’re breastfeeding, altered cortisol levels are in your milk too. Cortisol changes blood sugar metabolism and endocrine function; it can disrupt sleep, appetite, feeding, and immune response.  If implementing GAPS (or any special diet measure) is exceedingly stressful, pause; relax and enjoy your children; and  secure professional guidance so you don’t have to carry the nutrition-flip project on your own shoulders.

Meanwhile, here’s what can go wrong, when GAPS is the wrong tool for the job:

Fungal Failure – Recently an old study jumped out at me. It examined how children in weaker nutrition status can’t control Candida (fungal) species very well. They have more Candida, and different, more irritating strains of Candida in their intestines, compared to children in good nutrition status. The study found that for children, simply being in better total nutrition status meant better control of Candida colonization.

candida-1974

What exactly does this mean?

For kids, nutrition status = growth status. It is the single most potent predictor of how well a child will manage any illness or infection.

Nutrition status in kids is not a measure of how many vegetables or probiotic foods they eat. Not whether they’re gluten free, GAPS, or Paleo. Not what supplements they’re on, not whether they drink raw camel milk. No matter what a child eats, if growth pattern has wandered below that child’s innate trend, all body systems struggle more.

Even when children eat  lousy processed food, if they are in robust growth status, they still have more reserve to tackle a disruptive biome. Whether it’s a fungal load in gut, mycoplasma in lungs, MARCoNs in nasal passages, or a viral story in brain tissue, there is simply more energy and building material around to throw at it, in a kid with a strong growth pattern. This is such old news in nutrition science! Learn more about the cycle of malnutrition and infection in children here.

This does not mean that the quality of your child’s diet doesn’t matter. But it does mean that even if your child eats beautiful food, if they’re in a weak growth pattern, they are going to struggle more in every way – sleep, mood, infection fighting, learning, behavior – and, detoxifying a bum biome and healing the gut.

In the study mentioned above (from 1974, back when there were no GMOs, and less processed food available than is now fed to children worldwide), the groups compared were well fed white Australian children, poor aboriginal Australian children, and poor Indonesian children. The underfed children had weak total diets, meaning they had too little protein, too few total calories, insufficient vitamins and minerals, and sparse nourishing fats. They also had more Candida.

What does this have to do with GAPS? Read on.

A small child’s immune system will sputter when s/he’s underfed – like when eating just broth for more than a week. (Or when exclusively breastfed or formula-fed, with no solid foods, past the first year. Or when on deep dietary restrictions for healthy carbohydrates – which are fundamental to steady growth in children). There simply is not enough protein, energy (calories), and nutrients around to manage, balance, and fight. If an already weak, underweight child attempts GAPS, it may fail, because s/he was too depleted for multiple immune-essential nutrients and energy (calories) in the first place. A more recent study illustrates this well known tenet in infant and child nutrition: Just by not having enough food around, the gut barrier is disturbed, and tissue damage occurs. It doesn’t take long for this to happen in young children. Adding probiotic can hasten recovery, but only when an adequate total diet is also in place.

Hence the susceptibility to Candida – and quite likely, other bad actors in a gut biome, tissues, or organs. So although this first phase of GAPS may clear out some disruptive species from the gut, it can also drop your child’s total body immune response further, and permit other bum bugs to flourish. For kids who are underweight or have marginal iron stores to start, or who have deep total body dysbiosis, this can set up for failure. The detox is too fast, and the re-build fails, because the foundation was too weak to begin with.

Even mild nutrition deficits impact immune response in children. This is one of the reasons why GAPS fails. GAPS can be too restrictive for too long to help these kids recover. Just the introduction phase of this diet can take three weeks; this is an eternity for an already underweight toddler struggling at the bottom of the growth chart. Though broths, probiotic foods and egg yolks are fabulous, this may not be enough sustenance for a growth-impaired small child whose immune system is already straining. Yes, probiotics are critical to immune maturation – but, so is food itself, to nourish the gut tissue –> that harbors the biome –> that helps the immune system “learn”.

Carbs are especially essential for children. In infancy and toddlerhood, they are the fermentable food that normal gut flora require to thrive. Healthy gut flora make fatty acids like butyrate, which in turn fuel cells building your child’s gut tissue. I’ve met many parents who fear carbs, and over restrict them in their kids. This can fail too. Non-sugary, unprocessed carbs are a cornerstone to fuel the tutorials going on in a young child’s gut, between gut flora and the developing immune system. They also fuel growth and gain, and protect the lovely fats and proteins needed for other functions. The trick is finding which ones work best for your child’s circumstance. This is something I work with closely in my practice, for each individual child.

So even though GAPS aims to eradicate fungal load by restricting all carbs for a while and by adding extremely high potencies of probiotics with fermented foods, it can backfire. I often see disrupted stool cultures in kids coming off GAPS attempts, showing weak beneficial flora and ample dysbiotic bacteria, and even yeast in some cases.

When Leaky Gut Begets Leaky Gut – Some GAPS mainstay foods are renown suspects when it comes to intolerance or allergy. Eating broth with probiotic foods for three weeks is not long enough to clear pre-existing food antibodies, which circulate for months; in some kids, for years. If a child starts GAPS with hidden food allergy or sensitivity to egg or nuts, using these daily can exacerbate leaky gut, even when using that beautiful kraut or other probiotic food. I often find strong egg and nut reactions on IgE and/or IgG panels children who have used GAPS for several months. Even yolks   can trigger immunoglobulin reactions that may not show on the “drop on wrist” test suggested in the GAPS protocol.

egg-yolk

Better move: The “dot on wrist” test may not be enough. Do some food antibody testing before you start any special diet. Identify what foods are safest to work with before you begin. Check for both allergy (IgE) and sensitivity (IgG) to several foods, and work from there. If eggs and nuts light up your child’s panel, GAPS is not for you – or, it will be a bumpier road –  consider easier paths than GAPS to gut healing in this case – there are many options.

In my practice, I find that ALCAT testing is less useful. It tends to show too many reactive foods, which makes menu planning really difficult. Even when IgG and IgE panels are alight with multiple foods, in young children, it is not practical or healthful to remove them all. I will remove the top four or five offenders, rotate others, and dial in gut restoration tools suited to that child. This can include anything from simple organic aloe to direct herbal antimicrobial measures to products like Apex RepairVite to arabinogalactan, butyrate, glutathione, or a low FODMAPS + SCD compliant meal plan for a few weeks to start.

FODMAPS Meltdown – Many kids have difficulty with foods that are high in FODMAPs. Another GAPS mainstay, avocado (which is indeed a great food) is a moderate FODMAPs food that is poorly tolerated by many in my practice, especially babies and toddlers with FPIES. I am encountering many FPIES families who turn to GAPS, with poor results (vomiting to shock, blood in stool, lagging growth). Learn why FPIES may be as much about carbohydrate fermentation in the gut than it is about food protein reactions here. Meanwhile, if your child has FPIES, I would hesitate to recommend GAPS, because FPIES reactions can be severe and dangerous. I am seeing success with FPIES in my practice with other strategies, so if you need help, contact me for an appointment.

Dairy Dilemma – Dairy yogurts are another wonderful food that are simply wrong for some of us. If these have worked for your family, that is good. In my house, I can eat dairy while my husband and son cannot. I love raw goat milk. I have occasional organic yogurt binges. I eat ice cream, goat cheddar, sheeps yogurt, and whatever I want. My family can’t. I have countless children in my practice who show clean lab findings for any sort of dairy reaction from opiate formation to IgG, IgE, and ALCAT – but who still disintegrate terribly on dairy. Usually this is  a “behavioral” reaction – anxiety, impulsivity, rage reactions, stilted social processing, or poor sleep. For those moms who took my advice and tried the three month, uber strict, zero tolerance dairy free diet, and your kids got inexplicably way better, got off psych meds, and started to eat better, don’t thank me – I thank you. It’s hard to go out on a limb and try something that seems to make no sense. But, sometimes, a meticulous elimination trial is the only way to know if your child really can manage a food.

Are dairy yogurts okay for your child? If you really want to know what is going on, consider doing a Cyrex Array 4 for cross reactivity testing. Your child may react to dairy foods when eaten with other foods, and this panel will find if this is true for you child. This test plus sensitivity and allergy tests (IgG and IgE) can guide you before you begin.

Did GAPS Work For Your Kids? Great! Share your success stories here, I’d love to hear them. If it failed, don’t despair. Get individualized expertise for your child’s gut healing (and thus total body healing) journey. Your child deserves to visibly trend toward thriving. If you’re still struggling, get help, give me a call, set up an appointment. There are many ways to replenish, restore, and heal the gut; it’s okay if every kid is different. Honor your instincts as mom, because they are good as gold.

Top 5 Fails To Avoid When Trying Gluten Free For Kids

Top 5 Fails To Avoid When Trying Gluten Free For Kids

“We tried that, and gluten free didn’t work. Nothing really changed.”

Parents often bring that mantra into their first visit with me, as we explore nutrition pieces that might improve life for their kids. My next task is to find out exactly what they tried – because there are a lot of ways to fail at this, and it isn’t your fault. It can be complicated. Here’s my Top Five Checklist of “fails” to avoid.

Long and Strong – This one goes without saying, and most parents who come in know this already. Long means three to six months, not three to six weeks. It can take months for circulating antibodies to gluten or gliadin (a fragment of gluten molecules, equally if not more triggering) to drop off the immune system’s radar. As long as those are circulating, they can cause trouble. So, patience! And strong means zero tolerance gluten: No oats or oatmeal (anywhere, including in those “wheat free” cookies and granola bars), no special occasion exceptions (school parties, holidays, birthdays), no processed condiments or foods with wheat derivatives. Any processed food is suspect without label scrutiny first – everything from ice cream to soy sauce to supplements and medications can have gluten in them. Check everything! Start here for info on gluten in medicines or supplements your child may use daily.

Cross Reactivity – One reason why even the strictest gluten free diet can fail – even for someone with celiac disease – is that there may be cross reactivity with other food proteins. That is, the gluten molecules (or fragments of them) look a lot like other food protein molecules to the immune system – et voila! The body is hoodwinked into thinking you just ate gluten when you didn’t, and reacts anyway. This phenomenon is already demonstrated and documented in the scientific literature. The solution in that case? Ask your provider to run a cross sensitivity panel such as Cyrex Labs Array 4 to find out if this is part of the problem. Identify what other foods you might need to eliminate, and go from there.

Other Reactions – Continuing to eat foods that your child reacts to, even without the cross reactions described above, is another common fail. In this case, the immune system may not be confusing other proteins for gluten. It may simply just react to other proteins in and of themselves, and gluten. For example, it’s common for families to try elimination diets in which one food is removed at a time. That food is put back in rotation, and then another food is removed. The problem here is if a child reacts to both foods, neither elimination is going to show much of anything. The solution is to run IgE (allergy) and IgG (sensitivity) food antibody tests for several foods, and prioritize what foods to eliminate based on these findings. I specialize in helping families interpret these lab tests, and in building a healthy strong food intake when there are more than two or three foods to eliminate. You may end up finding that your child’s biggest problem is casein (dairy) or egg protein, not gluten. And while I don’t think gluten grown in the US is a great idea for anyone to eat, if your child feels better when avoiding dairy instead, fine – the idea is to do what helps your kid feel better.

What if kids show strong reactions to many foods? In that case, judicious rotations can work, with prioritized and strict elimination for gluten and perhaps two or three other top offenders; knowing cross reactions can help refine the plan too. Meanwhile, there are many ways to replenish your child with other equally nutritious or even more nutritious foods – ask for help if it’s overwhelming.

Biome Neglect – If there is constipation, diarrhea, bloating, gas, reflux, or picky eating in the mix, going gluten free is often helpful. When it isn’t,  your child may need some biome TLC. That is, Tender Loving Care for the gut! Clear out fungal or yeast overload in the gut, along with “commensal” bacteria or microbes that are taking more than they give. We all carry a few pounds of bacteria in our intestines, and we need it. When it’s balanced in our favor, those bacteria and microbes help us digest food, fend off invaders, give us back some vitamins to absorb for ourselves, and they actually communicate with our own immune systems and genes. When it’s skewed against us, a corrupted gut biome can cause painful chronic problems with picky weak appetite, irrepressible cravings for sweets, weak digestion, and sluggish bowels or diarrhea – not to mention mood disorders. Gluten free may fail if this piece is left behind. Get a functional stool culture, and tune up with the right probiotics or other tools to balance this part out. Then try gluten free with a toned up bowel biome environment.

Too Much Restriction – Especially for those picky eaters who love eating lots of starchy processed stuff based on wheat (pizza, bread, bagels, crackers, pasta, pretzels, cookies, noodles, mac and cheese), pulling the gluten can leave you wondering what they’ll eat. It’s a double edged sword that there are loads of good tasting gluten free versions of all those foods: Your child will have plenty to eat, but it won’t be so good for them. Neither is all that stuff when it has gluten in it. Either way, this style of eating usually leaves kids lacking protein, minerals, phytonutrients, antioxidants, vitamins, and healthy fats and oils – all of which are just plain essential. Your kid might grow, a lot, or may even become overweight eating this way. But sleep, behavior, learning, mood, immune strength, and bowel habits may suffer; depression, bloating, constipation, inattention, or anxiety may persist too. Gluten or no, this way of eating isn’t healthy, and your child may not experience much benefit from withdrawing gluten if other foods and nutrients are still missing. The next step is putting back what is missing, while keeping the gluten out. This may mean that your child needs to add protein, fats/oils, or some healthy grain-free carbohydrates from vegetables or fruits, or that some supplements are needed to gain full benefit. Even a deficit of just a hundred calories, day in and day out, can derail a gluten free trial – kids are growing, and need enough to eat every day to keep pistons firing for learning, sleeping well, and playing.

Still have questions? Start here with info on testing for gluten sensitivity versus celiac disease. Hope to hear from you soon!

 

How To Get Kids Off Miralax

How To Get Kids Off Miralax

Miralax is one of the most commonly prescribed drugs for infants, toddlers and kids. It isn’t FDA approved for them. It contains ingredients found in anti-freeze. Concerns for its toxicity have mounted (as they should – one child in my practice slipped into a coma during an in-patient, closely monitored procedure to give high doses of the laxative ingredient in Miralax to clear a fecal impaction). The label states it is only to be used by adults for up to seven days – but children have entered my practice who have been on it, with their gastroenterologists’ blessing, for years – which is not unusual. And when I meet these kids, they are still constipated, still unable to move bowels without drugs or suppositories, still picky eaters, and they don’t feel good. Their parents want them off Miralax, and so do I. Having messy, uncomfortable “applesauce” stools every day – or none – is not healthy.

The Truth About Miralax Use

The truth is, besides having potent toxicity for at least some children, this drug does nothing to treat causes of constipation. Like many drugs, it is a bandaid approach. What it does do is turn stool into mush, by pulling more water into the intestine. Children can go from being impacted with hard dry feces (very uncomfortable, and encourages toxins from stool or disruptive microbes to leach back into circulation), to expelling some mushy stool regularly. But, they can still be left with impacted, sticky fecal matter, despite using more, more, and more Miralax.

A common picture that I’ve encountered in my practice for kids on this drug is “overflow diarrhea” – that is, blow outs of loose stool every few days, with or without firm, hard, or dry plugs of stool. This overflow, which seeps around the impacted matter, causes staining in pants that kids (or teens) can’t control. For toddlers, it can explode up the child’s back and and down to ankles. Many moms have described to me the daily chore of stripping kids down, bathing them, and getting fresh clothing because this pattern covers their toddlers or babies in stool.  Older kids experience embarrassing stool accidents with this pattern. Needless to day, this is exasperating and concerning for parents – and miserable for kids. Regardless, it’s common for pediatricians to use Miralax indefinitely anyway: In 2013, Miralax was the fourth most popular drug in the “digestive” category, with nearly $180 million of it sold!

There are many other solutions. They are non-toxic, safe, and more effective. My top three interventions for constipation are…

Mycelial form of Candida

Mycelial form of Candida – Why you don’t want to go there

1 – Assess and clear fungal infections in the gut.

Prevailing thought in gastroenterology today dictates that nobody gets fungal infections, unless they are immune suppressed. It’s rare for GI docs to regard fungal infections in the gut as a problem. Your pediatrician usually won’t either. Their belief is that fungal microbes (aka yeast, Candida, mold) are normal residents in human intestinal micro-biomes. True enough – if there is little to no fungal growth there. A lot of fungal microbial growth is not normal. Without testing stool specifically for fungal culture, there is no way to know what is growing in there, or how much of it. Healthy kids can have fungal infections in the gut. Antibiotics, C-section delivery, prior thrush, using reflux medicine or use of some infant formulas can trigger fungal overgrowth in a baby or child’s gut.

Most GI doctors do not screen for this, but many functional medicine labs offer this test. I use it often in my practice. Why? Because fungal overgrowth in the gut can be quite constipating. A simple treatment with anti-fungal medicine can fix it. Drugs like Diflucan, Nystatin, or Sporanox do this. There are not many anti-fungal drugs out there, which is one reason why doctors are hesitant to use them unless they really have to – they don’t want resistance to develop to these drugs. But if a child is so constipated that they’ve spent years unable to eliminate normally or painlessly, or they can’t eat well, grow, or thrive, then it’s time to pull out those big guns (IMO!).

If your baby has had thrush – that is, a white coated tongue, or a diaper rash with white patches in stool – an anti-fungal medication may be offered, because thrush is a kind of fungal infection. But fungal load can persist deep in the GI tract, which, don’t forget, is several feet long. There is plenty of space between mouth and anus for fungal microbes to thrive. Just because the white coating on the tongue is gone, and the diaper rash too, does not mean the fungal infection is all gone. A lengthier course of medication can clear the problem, if it is lingering in colon or intestine.

Herbs can help keep fungal infections cleared out too. Common tools include tinctures or capsules of oregano, thyme, grapefruit seed extract, goldenseal, berberine, uva ursi, caprylic acid, black walnut, garlic, undecylenic acid, and many others. I often support my patients’ gut micro-biomes with herbal tools, so contact me if you need this help.

This product blends several herbs to help clear fungal infections in gut

This product blends several herbs to help clear fungal infections in gut

For entrenched fungal infections, I have not found probiotics alone to be effective. In fact, a popular probiotic used for intestinal fungal infections called Saccharomyces boulardii (“Sac B” for short) is problematic if used incorrectly and may worsen constipation. A more aggressive, multi-pronged approach is more successful: Direct clearing of the fungal infection with an herbal or prescription agent; different food; and, lastly, the right probiotic.

Strangely, while Miralax is not FDA approved for youngsters, anti-fungal medicines like Diflucan and Nystatin are approved for use in infants. They are safer. They can do a good job of clearing constipation from fungal infections, so explore this with your doctor if your child has been constipated for a long time. Don’t be daunted if you are dismissed. Find an integrative health practitioner who will help, and talk to me about non-prescription supports.

2 – Lose the reflux medicine!

Fungal infections worsen reflux, and reflux medicines worsen fungal infections. Click here for more on why you don’t want to leave your child on reflux medicine for very long. Like Miralax, reflux medicines are widely prescribed for babies and kids – some say over prescribed – but are not approved for use in those age groups. There are no proton pump inhibitors (reflux medicines) approved for use in infants age one year or younger. There is only one approved for use in children under age eleven years. Still, I have encountered countless infants and toddlers given reflux medicines only approved for adults, and left on them, for over a year or even two. This will worsen constipation, since it worsens fungal infections, and lowers digestive function overall. Using reflux medicine long term also diminishes uptake of many nutrients, especially minerals. Two children in my practice who used reflux medicines for over a year suffered fractures later on, and others have experienced stunting and delayed bone age. They were not absorbing minerals normally, and could not mineralize or grow bone as expected.

Talk to your doctor about weaning off reflux medicine if your child has used it for more than two months. There are many ways to improve digestion and diminish reflux without drugs. This is also one of my specialties in practice, so contact me if you need help. Changes in foods and use of herbs can gently enhance your child’s digestion while you wean off a reflux medicine. Correcting the gut micro-biome will help as well. Do this with guidance for better, faster results.

3 – Use Magnesium.

This one is so simple. Magnesium is an easy way to pull water into the gut without toxic effects from peculiar ingredients in products like Miralax (dyes, gluten, polyethylene glycol). Magnesium oxide is a stronger laxative than magnesium citrate; magnesium citrate is stronger than magnesium glycinate. There are other forms of magnesium besides these three, and depending on your child’s presentation, there is probably a magnesium option that can get him or her off Miralax. A very effective product, widely available, called Mag O7 is an ozonated form of magnesium that has worked beautifully for some of the most constipated children in my practice. Use this with guidance; the label instructions are intended for adults, and this dosing is too high for most children.

How much? Magnesium is calming, which is great, but too much is sedating and may slow heart rate. So this must be used with guidance, especially for infants or young toddlers. I choose which product and what dose, based on each child’s case. There are liquids, powders, and capsules of various magnesium products. One of the most popular is Natural Calm, available on many supermarket store shelves. A teaspoon gives 350 milligrams of magnesium citrate. This is a large dose for an infant, but may be perfect for a school age child. More than two teaspoons daily is not likely to be necessary and may be too sedating for your child. If you have any questions about using these products, especially if your child takes other medications, ask your pharmacist or pediatrician.

These three ideas are only the beginning. From foods to herbs to drug-free options, there are many ways to clear constipation that are not only non-toxic, but more effective than Miralax – and they create better overall health by replenishing and balancing the cause of constipation, rather than giving it a toxic bandaid.

Click on the graph below, to see the absolutely mind boggling amounts of money spent on “digestive” drugs. These data are only for the year 2103! Which of these has your child used, and which would you like to replace with non-toxic, healthy options? It’s possible. Need help getting your child off of Miralax for constipation? Contact me and let’s get started!

 

Digestive Drug Sales 2013

Kid Snacks To Replenish and Nourish Adrenal Glands

Kid Snacks To Replenish and Nourish Adrenal Glands

How do you get a fast between-meal feed for your kids without (a) slaving in the kitchen or (b) selling out to processed starchy filler from a box? We don’t always have time to make the gluten free sweet potato brownies or Paleo salted chocolate bacon bark. And it’s not great to rely on chips or cheese crackers day in and day out, even if they’re the gluten-free, super cute organic bunny version (it’s still empty processed food).

Kids need food and plenty of water all day long. They’re growing; both the athletes and the couch potatoes are burning more fuel per pound than you or I as adults. Many of my clients forget that their kids aren’t little adults. Sure, they can (usually) grow on the processed stuff: Mac and cheese, pasta, pizza, crackers, chips, fruit leather, cookies, power bars, cereal, squeezable yogurt, candy here and there. But you may be amazed at how different your kids act, grow, behave, and function, when you commit to less processed food and more real food.

...Meh

One of the “meh” things about processed snacks for kids is that they’re mostly starch, and weak on minerals, protein, or healthy fats. Doesn’t matter if they’re organic, gluten free, or blessed by a Bahai minister. It’s still simple processed starch – which rushes blood sugar up. In response, an insulin kick soon follows, to bring blood sugar back down and help it into cells.

Snacking on starchy sugary stuff day after day can lead to adrenal fatigue, because of the yo yo effect this drops on the pancreas, adrenals, and gut over and over. When insulin jumps to adjust a sudden sugar bolt from a starchy snack, next thing you know, blood sugar can drop too fast. That’s when adrenal glands help by popping out some cortisol. Cortisol is a fight or flight hormone that keeps blood sugar at the ready and suppresses insulin. Cortisol is released when we are under extreme stress; it sets off a cascade of metabolic effects to get you wide eyed and ready to do combat or flee. One of its jobs is to keep blood glucose on the level, when we really need it.

Normally, we have a steady daily cortisol rhythm that helps us sleep at night, maintain mostly level energy during the day, and feel alert in the morning. But with a routine of starchy processed food (or chronic stress, anxiety, or illness), kids are thrown into that metabolic yo yo every day. Kids who are prone to anxiety and relying on starchy grainy food can suffer undue angst with this eating pattern, because it triggers bigger pendulum swings in mood, energy, and self regulation.

Stressful Day Young Boy

Over time, this is a debilitating scenario. Chronically elevated cortisol feels exhausting. It also suppresses immune function, escalates anxiety, and can make your child more prone to infections. Though usual lab tests for adrenal function have reference ranges too wide to detect early adrenal fatigue, many providers can use symptoms and more sensitive saliva tests to check this more precisely.

How does this show up? Tantrums, crashes when hungry, can’t get moving in the morning, difficulty sleeping through the night, ongoing anxiety, chronic fatigue, frequent illnesses and infections (cortisol is released with illness too), hyperactivity followed by meltdowns… all of these signal a need for support for those hard working adrenal glands, which need minerals from whole food (not pills, though those are better than nothing!).. and some soothing healthy fats and oils.

Rotate in these actual-food snacks to avoid the insulin-cortisol roller coaster. and give your kids extra minerals, fats, oils and maybe a little protein too. Much better than chips every single day, though there’s no problem with having them in the rotation sometimes too. These can travel in zip lock bags or travel cup, or thermos for lunches. You’ll notice that fresh fruits don’t feature big in this list. That’s because they are great sources of vitamins, fiber, and phytonutrients that may have immune modulating benefits… but are not so great for the soothing minerals that our adrenal glands love.

Pumpkin seeds from jarRoasted Pumpkin Seeds – The favorite in my house are the spicy roasted ones (we need gluten free; they’re available plain, seasoned, raw, or roasted – check seasoning ingredients). Potassium, iron, and magnesium are the stand out minerals here. Kids who like really salty, spicy foods may go for these. Fine to work in some raisins, almonds, or cashews if trail mix suits your gang better.

Popcorn – What? Not the microwave stuff…

Coconut oil in panUnpopped corn in pan

Buy a jar of organic, non-GMO popping corn. Use a heavy flat bottom skillet with vertical sides. Cover the bottom of the skillet with 1/8″ to 1/4″ (not more!) of a good quality high heat organic oil, like non GMO canola or safflower oil. Then cover the bottom with a single layer of kernels – with some room in between. Cover, turn on high heat… and listen. In about the same time you would microwave a bag of corn, you have fresh, real-thing popcorn in a much healthier version and no toxic chemicals from a microwave bag. Remove the popped corn from the skillet to bowl once it stops popping – don’t wait or it will burn. Place a 1-2 Tablespoon blob of organic coconut oil in the skillet with the heat off. Let it melt. You can either pour the popped corn back into the skillet to coat it with the oil, or vice versa – pour the oil on the corn – and toss with good culinary sea or Himalayan salt. You can also use ghee for those sensitive to coconut. This is a more delicious treat than you’d expect. Though it’s not as fabulous on minerals as pumpkin seeds, it makes up for it with healthy fats, some protein, fiber, and cancer-fighting polyphenols. An easy do-ahead, if you need to pack some in the car or school lunch.

Cherry or Grape Tomatoes – In summer, you can’t go wrong. These are the ultimate finger food and the juicy squish-in-your-mouth is a plus for some kids. Local, organic ones often taste so sweet they Orange cherry tomatoesalmost feel like candy. Put these out and you may be surprised how they disappear. Fun to find different colors – from sunny yellow to orange to deep red, see which ones your kids like best. Skip the mega market non-organic ones, which lack flavor and feel like dry bullets to eat (IMHO!). Natural source for vitamins A and C, a smidge of calcium and iron, and sodium – which your adrenal glands actually need.

Kale Chips – You can actually buy these now (expensive): Oven roasted, salted kale chips are handy for feeding our adrenals with calcium, potassium, sodium, and phosphorus. They are simple to make too, if you have the chance, and really yummy when hot from the oven. Rinse and chop kale, removing the chewiest stems. Pat it dry and place it in a bowl. Work melted coconut oil or melted ghee with your fingers throughout the kale, rubbing both sides of the leaves to coat with oil. Toss with good quality salt and bake in a 350 degree oven for about 12 minutes, or until crisp and darkened. Even the staunchest vegetable-haters may melt for these salty, crispy treats.

Sweet Bell Peppers – Take advantage of these in season and buy crisp organic brightly colored orange, red, or yellow sweet peppers. Wash, remove seeds and membranes, and lay out strips for crunching on. They’re juicy, sweet, crisp, and play well with all sorts of dips, from hummus to Ranch to lime aioli. Big on beta carotene, vitamin A, and vitamin C but still a good option for potassium and a sprinkling of phosphorus, magnesium, and calcium. Also good for crunchy snap and sweetness: Sugar snap pea pods (open shell and pop raw peas in mouth!)  and young asparagus tips (young and narrow tips and stems are good eating, with or without a dip).

Avocado – Stock up on these and eat when the stem plug drops off with an easy press of your thumb. Avocados have magnesium, potassium, a good bit of fiber, and even a little protein. And the ample fats in an avocado are excellent for avoiding the sugar roller coaster and calming kids with a steady, slow release energy source. Toss ripe soft chunks with olive oil, lemon juice, salt, and sunflower seeds for even more minerals, protein, fiber and fats. Or you can make guacamole in a heartbeat by mashing it with a little garlic (fresh minced or garlic salt), salsa, and lemon juice, to boost your kids’ favorite chips into a better snack.

Got Broth? – As cooler temps approach, I like to have a jar or two of homemade broth on hand, and I make this from whole chicken (after roasting and enjoying the meat, keep the carcass, bones, and innards; simmer for a day with rosemary, thyme, sage, garlic, black pepper, some lemon or white wine, and good salt). Pour some out on a chilly afternoon, and sip plain. Broth gives soothing minerals plus a bit of protein and fats.  This also makes a fair breakfast for kids who are slow movers and not keen on eating early in the morning. Or for more heft, stir in some left over quinoa, fresh minced cilantro, scallion, some baby bok choy, Thai basil… and you have a reasonable facsimile of pho that makes ramen noodles look like… ramen noodles. Once again, adrenal-favorite minerals abound in this quick after-school soup for a cold day: Potassium, magnesium, calcium, and phosphorous. If making broth isn’t your thing, good quality organic stocks like Imagine or Pacific brands – beef, chicken, and vegetable – are readily available in quart boxes that don’t need refrigeration til opened. You can stir in that left over pasta, rice, or whatever your kid likes.

Like Juicing? Have A VitaMix? – Add celery, cucumber, fresh leaves of cilantro, parsley, or basil, raw ginger root, whole lemon,  apple, or any dark leafy greens to your kids’ favorite smoothies. If your juicer does not have a strainer, peel the cucumber and ginger root before juicing. These foods and herbs are soothers for stressed adrenals too. Good to combine with carrot, berries, peaches, pears, melon – let your kids choose and experiment for more buy-in.

Cantaloupe smoothie

Enjoy! I’m sure I’ve forgotten so many other good ideas for mineral-rich snacks… we didn’t even get to chocolate. Add your ideas and thanks for stopping by my blog.