I’ve been in pediatric nutrition practice for some 20 years, but these health and nutrition myths just won’t quit. They can keep kids sick when they could be enjoying better health. Here are 7 myths I encounter week after week. They’re powerful enough to steer your kids away from health and into being more sick, more often. Change your mind about these myths, and your kids may enjoy more health, more often.
Myth #1 – It’s normal for toddlers to be sick all the time …Um, not quite. Common? Yes. Normal? No. A toddler who rides a roller coaster of colds, infections, stuffy noses, coughs, diarrhea, or malaise every month, for more than 5 or 6 times a winter, with or without fevers, or who needs antibiotics over and over before age 2 or 3, gives me pause. So does a child who never gets a fever, but isn’t thriving either, and is often fatigued. Kids should not be sick more often than they are well. Yes, little tykes are vulnerable; their immune systems are developing, and if they were not breastfed, they haven’t been given that powerful foundation from mom’s immune system to protect them.
A cold or virus with a vigorous response – like a fever to 103 or so – that drops your child for a few days is a healthy and necessary challenge for the immune system to develop. But toddlers should bounce back, and resume a hearty eating pattern to restore depleted nutrients burned up during illness.
Nutrition and food make it possible for the immune system to work. When we’re sick, we make big withdrawals out of our nutrition bank accounts. For growing toddlers, this is especially costly – like borrowing money on a 25% interest rate! They need a lot of strong nutrition for growing, and for fighting illness, when they’re sick. We store nutrients for these occasions – especially iron, zinc, vitamin A, and vitamin D. We also use our own protein – which we store in functional structures like our organs, bones, muscles and flesh – to help fight infections. So if a child has a weak growth pattern to begin with, or is even just a little bit underweight, there won’t be much to work with if illness keeps knocking him down. A downward spiral of malnutrition and infection can ensue, and this is dangerous for tots.
PSA: Here we go with everyone’s favorite topic… The shot schedule. My 2p? It’s overloaded, fails often, and creates opportunity for mutation into more virulent strains of the viral and bacterial material in the shots. Vaccines can also cause the infections they are meant to prevent, such as in this case. The medical community understands overuse of antibiotics and has made big efforts to cut this back. Not so with vaccines. There is a mania that more are better. Believe me, my public health master’s degree gave me full indoctrination into immunization theory and practice. But these practices are not working, and after 20 years in clinical practice, I’ve had an about face. Despite having many more vaccinations than ever, kids are more sick and disabled than ever in US history, and not a single “vaccine preventable” disease has been eradicated. It is not because your neighbor opted out. It is because natural, long lasting, robust immunity from actual infection has all but vanished, and because vaccines can spread infection.
Vaccinated people can shed and spread infection from recent shots. This is called “secondary shedding”. Evidence of this is documented for flu vaccines, chickenpox, measles, polio, and many others. If you’re seeing your kids get sick when school starts…. it may be because everyone just got vaccinated and is shedding infectious material. Check out this sign at my neighbor’s condo association pool, barring anyone with recent vaccinations:
Dilemma: Your pediatrician’s bread and butter is giving vaccinations, and prescribing drugs. That’s about it. Since their degree required little to no deep training in nutrition, they may not recognize nutrition problems that drive frequent infections. If your child is sick more often than well, if colds and infections just won’t quit, what to do?
- Have your child’s levels of quantitative immunoglobulins checked. Low immunoglobulin means low defenses. Good nutrition and food build this back up eventually, but other special measures may be needed.
- Improve your child’s growth pattern. Are they underweight? Are you sure? Even being modestly underweight may drop immune response and defenses.
- The immune system needs iron. When it’s depleted, infection fighting is harder.Check iron status with a full iron study, not just with hemoglobin (Hgb) and hematocrit (Hct). Hgb and Hct are crude measures that capture only profound anemia. Ask your doctor to do a full iron study to see if your child is pre-anemic. An iron study includes ferritin, serum iron, transferrin, and saturation. Don’t start iron supplements without guidance – iron can be poisonous at the wrong dose.
- Get your child’s vitamin D level checked. It should be well above 30. At our office at Flatiron Functional Medicine, we look for levels in the 50-80 range for good immune protection.
- Get your child’s vitamin A level checked (also called serum retinol). Vitamin A is crucial for immune function, and upper respiratory infections, measles or chickenpox in particular. Unless your child likes to eat liver, cod liver oil, lots of fortified dairy food or grass fed butter, and/or orange and green vegetables, a marginal or even deficient vitamin A level may ensue. Marginal or deficient vitamin A places your child at higher risk for complications from measles or measles vaccine.
- Don’t vaccinate a sick child.
- Breastfeed as long as you can.
- Camel milk is a good source of potent immunoglobulin. Consider using a few ounces daily. If that’s just too weird, consider using a bovine serum derived oral supplemental immunglobulin like this one, or colostrum, if your child tolerates milk protein.
- Keep your child home after vaccinations if they don’t feel well. Avoid recently vaccinated peers just as you would avoid a sick child.
- Balance your kids’ meals and snacks so they get about a third of all their food as fats or oils, about half as clean, non-processed, non-sugary carbs, and about 10% as high value protein. Vary the protein they eat, so it isn’t always the same source.
- Use as much organic food as you can afford. Pesticides in food burden the immune system further.
Myth #2 – Picky Eating Is A Willfull Behavior Choice ….Followed by “your kids need feeding clinic” (maybe they don’t) and “they’ll grow out of it” (I have many kids in my caseload in their teens who …didn’t). Nope nope nope.
Picky eating is a downstream effect of three things: Gut dysbiosis, mineral imbalances, and exogenous opiate peptide formation from wheat, dairy, soy and pea protein (like Ripple milk, or plant based protein powders). Watch this short video for a fast explanation.
What sets this up? Reflux medicine, C section delivery, antibiotics (for mastitis, at delivery, during pregnancy, for your child, or a long history of your own yeast infections and dysbiosis prior to pregnancy), early vaccinations… That’s where it begins. This parade of interventions and pharmaceuticals from birth insidiously but profoundly change the gut biome away from a healthy early profile and toward disruptive microbes like Candida, Rhodotorula, Klebsiella, Prevotella, too much Staph or Strep, or even Helicobacter pylori. Sometimes I will see a protozoan pop up on DNA screen stool studies too. These in turn usurp minerals out of the diet and make them harder to absorb too, due to subtle shifts in pH in the digestive tract that these microbes create. Ultimately, appetite can drop, the poor diet begets more poor diet, because weak zinc and iron status tend to trigger pickier eating. Next, this scenario also degrades digestion of proteins. When proteins like wheat, dairy, soy and pea are poorly digested, they become “dietary exorphins” or “food derived opioid peptides” that trigger effects on the nervous system.
Once this is in play, your kid is indeed addicted to that white diet (Goldfish crackers, yogurt, noodles, milk, milk, Pediasure, milk, more milk, cheese, pizza, mac and cheese, pasta, bread… and of course sweets). Other foods will be absolutely refused even if you let your child go hungry – because other foods don’t give that opiate-like kick. There is literally addiction chemistry here working against your child. Sure tells that this is happening to your child, besides the fierce picky eating, are hyperactivity, behavioral volatility, dilated pupils after meals, and/or delays in expressive language or socialization.
Breaking this pattern can be done. I’ve helped hundreds of families break it, and it has nothing to do with convincing your child to like something else, or sitting through agonizing feeding clinics where your child is pressed to place different foods to their lips against their will.
Full disclosure: The only thing that makes a nutrition intervention, and not a behavioral one, for this fail is when parents bemoan how hard it is. Yep, it’s hard. But it can be done through a methodical reboot of your child’s gut environment, with individualized strategies for supplements and new foods. Start with this e book if you want to break picky eating. Spoiler: Probiotics alone won’t fix this.
If your child has mechanical issues with swallowing and feeding, then of course they need feeding therapy. For other kids, unless the underlying nutrition and gut biome problems that cause picky eating are professionally assessed and corrected, feeding clinic may not be necessary or helpful.
Myth #3 – Kids Get Constipated Because They Choose To Hold Stool – Gaining potty skills is a process for sure, and some kids do get flummoxed around it to the point of trying hard to withhold stool. In 20 years, I have had one legit case of this. For all the hundreds of other kids, they were constipated because of (a) disrupted gut biome and (b) dietary exorphin formation.
Most of these kids had Candida or fungal microbes flourishing in their intestines. How did we find out? We did urine and stool studies to show it. These are not yeast infections that their pediatricians noticed – because the kids didn’t seem outwardly sick, didn’t have immune suppression, and didn’t even always have white flecks in stool, white or grey coated tongues, flat or concave nails, or ringworm rashes (all tell tale signs of fungal dysbiosis). What they did have were bloated bellies that wouldn’t quit, fierce cravings and picky eating for starchy processed food or sugar, behavior challenges, lots of Miralax in their histories, and, constipation. Some of them also had epic battles with bedwetting into their tween years, which turned out to be a Candidiasis of the urinary tract.
Clearing the dysbiosis does the trick. This takes thoughtful intervention with probiotics, antimicrobial herbs, or in some cases, prescription anti fungal drugs, as well as some upgrades in what these kids eat. I choose all this stuff based on each child’s history, labs, and presentation.
The other constipation trigger here is the opiate peptide business (See Myth #2). Casein digested into casomorphin, or gluten digested to gliadorphin, are both powerfully constipating – after all, they have opiate-like effects, and if you’ve ever needed pain killers for a surgery, you know the drill. In some cases, the constipation doesn’t quit til those proteins are 100% strictly removed for at least three months. Because soy and pea protein concentrates do the same thing, swapping out milk or wheat protein for pea or soy can fail. Ripple milk, Vegan Orgain, and any plant based protein powder may have pea protein concentrate or soy in it and will continue the constipated pattern in some cases. Digestive enzymes may help, but this isn’t as effective as removing the offending foods. If you use enzymes, buy one that has dipeptidyl peptidase IV in it (DPPIV) at a high concentration. After some gut repair and good nutrition replenishment, wheat and dairy may be fine once again, but don’t expect results from a reduced intake of these foods – they may have to entirely vanish to get your child pooping again.
Myth # 4 – If my pediatrician didn’t say so, it’s not real – The American Medical Association and the American Academy of Pediatrics don’t require rigor with respect to nutrition, for those getting MD degrees with specialty in pediatrics. Only about a third of doctors routinely discuss nutrition at clinic visits, and most report they don’t feel adequately trained in nutrition (they’re not).There are big knowledge gaps for pediatricians when it comes to nutrition. So when you go in with questions about foods, supplements, or special diets, you may come out empty handed at best, or chastised at worst. Don’t stop there, or assume there isn’t a solution, if your pediatrician can’t answer your questions or tells you there’s no evidence that a nutrition measure might matter.
Odds are, there are some very good data on whatever your question may be. Nutrition is a thoroughly pedigreed science that has been around for well over a century. There is so much possibility to engage information, research, and clinical experience from it that your pediatrician may not know about. Naturopathic doctors have more training in it, as does a pediatric nutritionist/dietitian (that’s me). Adding these resources to your care team can give your child better odds for better health.
Myth #5 – Cavities? #ThisIsFine – Cavities are no fun for anyone. Even kids who have good oral hygiene can end up with repeat visits to the dentist, for drilling, filling, capping, or extractions. It may seem entirely usual that everyone gets them. Well, not everyone does, and no, cavities are not a necessary childhood rite of passage.
Cavities are a canary-in-the-coal-mine scenario. They can be thought of as a flag for a disrupted oral microbiome, and/or a shortage of the strong nutrition that helps build teeth and enamel. A healthy mouth will harbor friendly microbes that do a good job of intervening on your behalf, and don’t let an overly-acidic environment erode enamel. And, a baby who gets to breast feed a long time will have a better shot at less crowding of the teeth, and thus less chance for cavities.
If your child has a frequent flyer punch card with your dentist, start with gut. Your child’s gut microbiome may need an overhaul away from Candida, yeast, Helicobacter pylori, or other disruptive species. These are fed by simple carbs, sugary food, and processed foods. If your child is picky, see Myth #2 above, and set a goal to bust that pattern. Ditch the reflux medicine if possible (if you’re using it), because this reduces absorption of both protein and minerals – two key components of teeth. If children have optimal nutrition during the time that teeth develop, they can avoid cavities. Vitamins A, D, K, and C along with healthy fats and protein, with wholesome vegetable sources of carbohydrates, can accomplish this task. For more on nutrition and cavities, visit the Weston-Price Foundation.
Myth #6 – Measles and chickenpox are deadly diseases. The short answer here is, yes, and, no.
So much has been said about this in recent years – most of it counterproductive – that it’s hard to consider bringing this up at all. As a senior practitioner who has been credentialed in my field for over 30 years, I can say the sea change in this has not been worthy. It has not translated into better health for children. The conversations now afloat, where anyone questioning vaccines is pilloried and branded insane, would have been shocking during my graduate studies the late 1980s. We were allowed, and encouraged, to question and investigate, as were our mentors and instructors. This was not forbidden in that day, as it is now. And yes, I studied immunization, epidemiology, and nutrition as a graduate student. Yes, I know of deaths from these diseases. Among my classmates were physicians and health professionals from Taiwan, Indonesia, Africa, Egypt, Pakistan, Vanuatu, Guam, and the like. For our graduate practicum rotations, we were flung to all corners of the globe, including underdeveloped locales where poverty and malnutrition were common. My classmates went on to positions in clinical practice as well as in policy, including for WHO, USAID, and the CDC.
Measles can kill a child in poor nutrition status. So can chickenpox, flu, or a common cold. Here is the lost part of the conversation: Nutrition, not vaccination, makes or breaks this for a child. For decades, the World Health Organization (WHO) has emphasized nutrition protocols for controlling infectious diseases, and for measles in particular (see Table 1 here for just one example and Table 2 here for another). Why? Because the immune system only works if it has nutrients to draw on to make immuglobulin, white blood cells, NK cells, a thymus gland, and so on. It can’t work from just a poke in the arm with a bunch of antigens and toxic adjuvants in it. It needs the body’s nutrients to respond. My classmates in public health knew this, witnessed this, and applied it. They did not go on caterwauling about vaccination, condemning people who deferred, or indulging emotional, religious-fervor, carte-blanche approval to using vaccines without limits. We understood that nutrition status was, and still is, the primary driver of whether or not a child may die from an infectious disease, have complications, or survive it handily. Whether you derive it from an injection or a natural infection, there is no immunity without nutrition to build it – period.
This is now so polarized a topic that effective discussion is impossible. Young parents have succumbed to relentless fear mongering and misinformation from the pharmaceutical industry (via its alliances at the AAP, FDA, and CDC) while actual science has fallen by the wayside. Millenial parents are in lock step out of fear of becoming social pariahs, willingly submitting their children without question, lest they be accused of being “unscientific”. At the same time this generation can grasp that the oil industry has lied about climate change since the 1960s, it is somehow lost on young parents that the pharmaceutical industry is, likewise, lying to the public about the safety (and efficacy) of its single most profitable sector. As long as pediatricians remain poorly informed on nutrition, they too will readily believe that an ever growing vaccination schedule is the only way to have immunity to anything. It isn’t.
For kids in strong nutrition status, measles and chickenpox are survivable and beneficial infections. Not only do these infections give effective immunity that lasts into adulthood, having had acute fever inducing infections in childhood like measles may lower risk of certain cancers later in life. Strong nutrition status means robust stores of iron, zinc, vitamin A, protein; access to clean whole foods and the appetite to eat them; and a body mass index somewhere between the 25th and 80th percentiles.
Nutrition and infection is a vast and complex topic. Our pediatric physician community is tragically not well versed in it. Hence, we have a nationwide army of pediatricians believing that only vaccines can prevent infection, while at the same time depending on giving them for their livelihoods. The truth is, not a single disease has been eradicated by vaccines so far, and like any other pharmaceutical product, it may not suit everyone. The strong arm tactics afoot to force vaccination are highly suspect – if a product truly works well, no one would object and no one would need to be forced to use it. In fact, vaccination itself may have loosed more virulent strains of several previously mostly benign infections, besides destroying the natural immunity that humans developed over eons of time.
If your child contracts either measles or chickenpox, consider these guidelines from Mayo Clinic. If your child has been growing well, eating well, and not picky prior to illness, odds are they will have the nutrition reserves to weather this successfully and will be gifted with robust immunity for many years. Vitamin A is crucial for fighting measles. Supplementing it during this illness may be necessary. If your doctor doesn’t know how to do this, see these WHO guidelines (Source – see page 45):
Myth #7 – Elimination diets will make my kid different and there’s nothing to eat anyway – When I became a mom, despite my degrees in nutrition, I knew virtually nothing of elimination diets or food allergy. I soon found myself on a steep learning curve. This was in the mid 1990s. No internet, no online support groups, no other moms in this boat. I was isolated, and cracking into my training, texts, and visiting medical libraries all over again, just like in graduate school. My son needed to eliminate gluten, soy, egg, dairy, and nuts back when nobody did this. Nothing could be bought ready made, including bread (we eventually found Kinnikinnick bakery in Canada, but that was the only one for years). I was often quite unwelcome at school events, family gatherings, or birthday parties because I would show up with “weird” food that my son could eat. I always made enough to share. I always asked hosts ahead of time if this was okay. Eventually, it was …fine.
We didn’t talk a lot about this in my house. We just made food. It wasn’t my son’s problem, it was mine. I was the adult, and it was my job to give him the freedom to eat and feel good, rather than eat and feel sick, like any other kid. If anyone had a problem with that, well, insert expletive here. He gets to be well and happy too. This was my mantra.
This made me learn a lot about food, cooking, and baking that I didn’t know. I learned how to make really good food and really fun and delicious treats for holidays and birthdays. It made me do a better job than I would have, of feeding my family.
If I could do it in the dark ages, you can do it now. There is so much awareness for food allergy now, not to mention thousands of food products out there ready to buy, mix, cook, bake, or just eat. Get to it. If you need help, let me know.
How do you get your kids a decent lunch at school? You’re over the top with beautiful Bentos, containers, and boxes for all the best snacks and sandwiches you can think of, you’ve tried every healthy power bar, fruit, carrot sticks, rolled up turkey, hummus… You’ve resorted to the junk: Cheddar Bunnies or Goldfish, pretzels, chips, sugary granola bars… and it comes back barely touched at the end of the school day, right? Or you’re buying school lunch, but have no idea what it is, whether your child eats it, or why they come home and melt into tantrums day after day (hunger, maybe?) Here’s five tips to help this go a little better.
1 – Let yourself off the hook – and your kid too. You’re not the problem. Neither is your child. The school is. Lunch is too short, too chaotic, and too impersonal. Incredibly, some children literally don’t get to eat lunch at all, as they spend too much time lining up to get it and finding a table. Here is one example of a school where children actually dumped untouched trays of food in the trash because it was time for recess by the time they’d gotten their lunches – they never got to eat at all. No amount of curriculum is worth this. You can stuff curriculum into kids’ faces all day if you like, but guess what? It won’t work. Because when children are hungry, attention and learning drop. Hmm maybe this is why we hear that US kids are falling behind compared to other countries?
By contrast, check out this story and video about how school lunch is served in France. Imagine how differently children learn to value food, community, self worth, and social interaction, when they get to eat this way. Oh well. We are probably not going to get there anytime soon in the US. But I share this to illustrate how absurd it is to expect children to function well in our version of a school lunch system. It does not engender health, good digestion, or appreciation for food, self, or how to contribute to a positive group experience. Our system is downright competitive, and anxiety provoking, as kids must worry about what they’ll get, when they’ll get it, if they can eat it, how fast, where to sit… and must do it in a cacophony that could make your ears bleed. So give in to the fact that how your child eats at school is something you can’t likely change, at least not this week. Make up for it with family meals at home as often as you can, whether it’s breakfast or evening meals. Having family meals together on a regular basis has been shown to boost kids’ vocabularies, grades, and intakes of nutrient-dense foods.. and it lowers high risk behaviors in teens like drug use and drinking.
2 – Let your child eat what is easy during the school day. Literally, anything is better than nothing. Pack high protein finger foods, starchy snacks (yes, you read that right), and comfy favorites. Don’t worry about the carrots and celery that come home. They’re not going to help much anyway during the busy school day. Your child needs high density food. Their brains use nearly half the total food energy they eat every day, just to be and learn (adult brains use about half that amount). Starchy snacks give fuel quickly and while we can argue all day about why they’re bad, they are better than nothing. Think of it this way: You’re flight was delayed and your stuck in an airport terminal at 4 AM with nothing open for food. You never had dinner the day before or breakfast this morning. But wait: You found some crackers in your purse. Eat them, for God’s sake! Yes, it’s junk, and, it will give you a little help til you get to your destination. It’s not what you’re going to eat every day, but you’re glad to have it in that moment. Likewise, don’t sweat it if your child is eating some low value starchy snacks during the school day sometimes. Avoid processed high sugar or corn syrup snacks – but a blondie brownie (gluten free if necessary), made with strong organic ingredients, coconut sugar or maple syrup instead of cane sugar, and some awesome ghee or coconut oil for a brain boosting fat isn’t at all that bad. If allowed at your kids’ school, throw in some crushed cashews or other safe nut. A dense homemade or store bought bar every day with clean ingredients isn’t all that bad.
Lunch at an Iowa school, 1939 (courtesy Library of Congress)
3 – Fast finger foods are an obvious help. Expand on the starchy goodies by including some protein and fat rich options, like olives, hard boiled eggs, jerky or meat sticks, or collagen bars like BulletProof, Dr Axe, BonkBreaker, Caveman, or Perfect Bars (some from this brand have peanut). Other bars may source the protein punch from dairy, using whey or casein; you’ll need to skip those for a dairy free child. You might also see soy, rice, hemp, or nuts as protein sources. Scrutinize ingredients to fit your child’s needs. Generally, grass fed collagen is a good protein source that is non-allergenic for most kids. Another great option: Fat bombs, bite size power packed snacks that are easy to make at home with a few ingredients, and are beginning to appear on store shelves in various forms. Here is just one site that offers a cache of 45 fat bomb recipes. Look around the web for more from sites like Paleo Hacks, Paleo Plan, or under names like Paleo Energy Balls. Those recipes use nut butters often; some schools have a zero nut policy while others only limit peanut or have a nut free table. Lastly – macadamia nuts, if allowed at your child’s school, have the highest fat and calorie content of any nut. Even a few nuts give high octane fuel that can make the day’s journey easier. Ten nuts yields about 200 calories. Throw in a few organic, stevia sweetened chocolate chips if you want to make it a treat that skips sugar.
4 – Make the liquids count. Instead of juice pouches or boxes, consider a midday meal replacement power shake that adds fat, protein or micronutrients. Options abound for ready to drink stuff you can pack in your child’s lunch. Orgain drinks are widely available (even at Costco) in both vegan and dairy protein source versions. The vegan version is gluten, dairy, and soy free. I also love Rebble Protein Elixirs. A little pricey, but they are dairy, gluten and soy free, with big protein boosts from pea, sunflower, pumpkin seed, or hemp. They are less sugary, more nutritious, and cleaner than stuff like Boost or Pediasure, which are high corn syrup and low nutrition value with only GMO fed cow casein and GMO soy as the protein sources.
Many kids with severe allergies need an even more specialized product. One example is Splash ready to drink elemental formula for children. Though many in the integrative nutrition communities love to hate this stuff, in certain cases, I have seen it be quite successful for children with feeding difficulties and multiple food allergy. Downside: High cost, but may be covered on insurance for kids with documented multiple food allergy.
You can of course also always make your own smoothie and send it to school in a single serving container, but keep in mind that this makes more work for you, and it may take more steps for your child to eat it than products that come with a straw or easy open cap.
5 – If all else fails and your child is simply not eating lunch, meet with your school principal and teacher to troubleshoot. Ask if you can observe a lunch period, volunteer during lunch, or work with an advocate to observe for you, so your child isn’t seeing you at school to watch lunch (they will most likely behave differently in your presence). Is your child last to get to the table, struggling to know where to sit, klutzy with the tray tasks, overwhelmed by noise, too excited to socialize to eat? Identify what is not working. Solutions might be quieter seating with a lunch bunch rather than in the cafeteria en masse, leaving two minutes sooner to get to cafeteria with a peer, or reliable seating at a regular spot. Further ideas are talking to your principal about aligning recess before instead of after lunch, expanding the lunch period by a few more minutes, or creating conduct rules at lunch for noise or behavior for the whole school. In my son’s elementary school, lunch included clear conduct rules that meant no one left the table until everyone had finished eating and had cleared their trays/lunch sacks and trash. This meant that at the end of the half hour (yes, they had 30 minutes), twelve little angels were usually seated quietly waiting for the signal for the whole table to go out and play. Rather than bench seating or loose chairs, the cafeteria had tables with single circles integral for each little behind, like this. These omitted crowding or jostling for space. Find power in numbers with other parents for these larger changes.
When I was a kid, we actually got bussed home in the middle of the day for lunch. My school did not have a cafeteria. We were picked up, brought home, I had lunch with my mom and siblings, and got back on the bus to go back to school. I had a full half hour to eat once home. I never felt rushed or worried about lunch. It’s hard to believe this is how it used to be in an American public school. Times have changed, budgets are squeezed, moms aren’t home to serve lunch. Maybe someday our school system will reboot how it does lunch time to something more conducive to learning, but until then, give your child these options to at least get through the day on more than fumes – they deserve it!
Functional medicine is all about resolving the root cause for chronic conditions, by giving the body tools to repair and heal itself beyond just prescription drugs to mask symptoms. The idea is to be well to potential, not just un-sick. But there’s a problem, when it comes to babies, toddlers, kids and teens: Those people are not little adults. The functional medicine model that works for grown ups sometimes leaves out critical pieces for kids – and I see these mistakes in my pediatric nutrition practice, regularly!
If you know me, you know I work in an office with a fabulous functional medicine doc, author, and speaker Jill Carnahan MD. Before moving into our new office digs in 2015, we shared space with Robert Rountree MD, another renown educator, author, speaker and founding IFM member (here’s just one of his fabulous pearls of wisdom). Just being in the same room with those two is a joy, as both are fonts of knowledge and experience!
I meet many kids who have come into my practice having already worked with a functional medicine practitioner elsewhere in the US – but often, these kids are still sick, not getting better, or even getting worse. Does this mean functional medicine doesn’t work for kids?
Nope. It means a few key pieces got left out. I see this a lot. Work these bits into your child’s care with your provider, and things might go a lot better. Here’s the top 3 goofs that I encounter, when working with families who tried functional medicine care for a child, but didn’t see great results.
1 – Your Doctor Forgot About The Food
Sounds crazy, but it’s true: The most important piece for children of any age to feel better with a chronic condition (or even leave it behind) is food. How much? What protein sources are safe? How much fat? What carbs are okay? What do you make for dinner? What goes in the lunch box? How many ounces of formula, and what formula is best for the baby? How much breast milk? Should mom be on an elimination diet too? Which foods should she remove, which foods can she replace those with? Should your child eat fermented food, GAPS, ketogenic diet, Autoimmune Paleo (AIP), gluten, low oxalate foods, avoid nightshades, low FODMAPs foods?
All those questions need specific answers and specific instructions.
But… What I often see is that parents are just told what not to feed their kids, without details about what to feed them instead. This often leaves kids over-restricted, not eating enough. I also find that foods are eliminated without a good reason (“aren’t carbs bad for you?” … “I was told potatoes are inflammatory, so we cut those too.” … “I don’t want to feed yeast – the doctor said to go ketogenic just to be safe.”) Or, sometimes, a food that is not a fit gets over-used, like daily high oxalate juices with spinach, kale, and beet juice; or coconut everything, when we find coconut to be a high IgG trigger food or too high FODMAPs for that child. Long short, you really gotta know what food is right for your child, and how much. That is based on lab studies, signs, symptoms, and history – not on any dogma about the “best” diet.
The flip side of looking in detail at what and how much your child is eating daily is growth pattern. Growth is the single most important measure of a child’s nutrition status, especially in children under age five. It can be assessed in great detail, to include stuff like Z scores for body mass index for age, velocity, regression, or level of malnutrition. This is a big blind spot in the functional medicine model, which was borne out of how to manage chronic conditions for adults – who aren’t growing!
Growing dramatically changes how we use energy (calories), protein, fats, carbs, and even some micronutrients like folic acid, zinc, or iron. Just your kid’s brain uses more energy per ounce daily than yours does! Not to mention all the other stuff going on in a growing person.
I request a food diary with each new patient intake, and often at follow up appointments too. This isn’t about watching what parents are doing right or wrong (it’s not about you!). Food diaries reveal a lot about a child’s body, what they feel like eating, what they are absorbing well, what nutrients they may be losing, why they are fatigued or hyper, or what sort of dysbiosis may be active.
Matching this info up with a growth analysis is a gold mine of information about why a child isn’t feeling well. Growth impairments can be subtle or even invisible, without a skilled assessment (which pediatricians generally don’t do either – they don’t have time). Even mild growth impairments matter – they are costly for children. They affect sleep, behavior, mood, self regulation, timing of puberty, and stamina.
And.. Guess what: That Holy Grail of healing leaky gut? It can’t and doesn’t happen when a child has a growth impairment. Just being even a little underweight can, in itself, make a child’s gut leaky. The functional medicine community often overlooks this. You can eat all the kombucha and bone broth you like, but if you’re five years old and off your expected growth pattern, it won’t work so well. There won’t be enough energy and construction material to manage the demands for growth, and the demands of tissue repair and restoration. These heighten a child’s macronutrient needs (protein, calories, fats, and carbs) dramatically – and they have to be the right macronutrients for your child… Or, you guessed it, all your efforts can flop.
I often find that a child will be sprinkled with supplements for toxicity and neurotransmitter support, when all they needed to function better was the right food in the right amounts, consistently, day to day. The only way to find this out is by looking at detailed food diaries and making a deep dive into growth data – including life long growth pattern from birth. This helps identify what the expected growth pattern is in the present day.
2 – Your Doctor Ran Too Many Fancy Lab Tests
…that didn’t really add up to an action plan for the family.
There’s no shortage of super interesting lab tests available now, that broaden our understanding of how the immune system is managing food, how we manage toxic exposures, or what our microbiome is up to. But what do you do with it all?
Sometimes this information isn’t actionable. That is, there isn’t going to be anything you can do with it.
For example: A Cyrex Panel 3 for Wheat Proteome Reactivity and Autoimmunity is as detailed as you can get, to see what an immune system “thinks” about gluten. It costs about $300, out of pocket. But if you’re just trying to figure out if a gluten free diet would help, all you need to establish that is deamidated gliadin antibody test. Your pediatrician or PCP can do that, and bill your insurance. (Your pediatrician will tell you it’s “normal” if the result is less than 20. But I will tell you to withdraw gluten if your child has any suspect symptoms for gluten intolerance, with a value above 10). Even if you pay cash for this simple test, it isn’t likely to cost more than about $50.
Or you might see a test for red blood cell toxic and essential metals, like this one. I like this test because it captures a lot of information in one sample. But, in children especially, iron needs more detailed digging than this test can show. If iron is marginal, it’s easier to absorb toxic metals like lead. The only way to know if iron is truly marginal is to do some standard stuff that, once again, your pediatrician can do very inexpensively or on your insurance. Include ferritin, CBC, transferrin, saturation, and serum iron to get this picture. Plus, kids show signs of mineral deficits clearly in behavior, sleep pattern, mood, hair, or skin. For children, a nutrition focused physical exam should be included in assessment too, not just lab tests. And by the way, here in my practice and in the practice of Jill Carnahan, we don’t use hair testing for mineral analysis, because we don’t find it to be terribly accurate or useful.
Another popular (and costly) test is the NutrEval by Genova Diagnostics, which runs close to $400 out of pocket. Some insurances may cover this test; in my own practice, this is rare. Many functional medicine docs rely on this for nutrition assessment. While it does do several tests for one fairly decent price, it does not assess children as well as it does adults. Nutrition assessment in children must include growth and food intake data, as well as clinical signs and symptoms. No one lab test can do this, even a comprehensive panel like the NutrEval. Because it is sold as a comprehensive, complete tool, it tends to mislead into thinking that all solutions lie in the supplement protocols that come with your test results. How often I have seen this fail!
The NutrEval also includes an analysis of essential fatty acids. I think you can skip that: It’s easy to see things like essential fatty acid deficits in kids, based on their food records (are they eating any?), behavior, and clinical signs that relate to essential fats. You don’t really need a blood test for this in my opinion, unless you are revisiting how to dose a fatty acid supplement protocol that doesn’t seem to be working. Even then, you can check other parameters in signs, symptoms, or other less costly labs to find out.
Another common misunderstanding I encounter with parents who have done a NutrEval is they believe that their kids’ protein status has been assessed, because there is an amino acid profile in it. Amino acid profiles don’t assess protein status or intake, which is crucial for kids. The amino acid profile rules out inherited metabolic disorders, another common and often insurance-covered test that you don’t need a functional medicine doctor to order for you. Protein status in kids is assessed with a metabolic panel (a common and cheap LabCorp or QuestLab test that your pediatrician can do), and by looking at clinical signs, growth, feeding, and elimination patterns.
For more cost saving tips on what lab tests to start with, without spending thousands out of pocket with a functional medicine doc, see my e book on 5 Essential Lab Tests For Kids With Autism. Goes for any kid, with a chronic condition! Any practitioner skilled in Nutrition Focused Physical Exam for children can save you a lot of time, trouble, and money – and help you avoid a care plan that backfires.
3 – Your Child Has Been Over-Treated, or Treated Too Aggressively
There are so many cool tricks and tools for wellness potential that insurance doesn’t pay for. These are the things that your functional medicine doctor is trained to use – cutting edge stuff that includes everything from far infrared saunas and nutritional or immunoglobulin IVs, to highly specialized supplement protocols and ozone suppositories, or novel ways of using prescription drugs off label, for special circumstances. It’s hard to hold back, when we want to help people heal!
But here’s the thing: Children are delicate little creatures. Especially really young ones, like, babies. Or kids of any age who have been overwhelmed with mold toxicity or Lyme disease, or who didn’t tolerate the vaccine schedule. Their bodies are overwhelmed. Don’t overwhelm them all over again, with a barrage of treatments, all at once.
I have seen children go from bed-ridden to literally jumping, enjoying school, and playing normally again simply by suggesting a family stop treating their child for all these found problems, and by helping to re-boot with nourishing, gentle foods that fit that child’s needs. Then we pick and choose which “layer” the child might successfully address first. Are they anemic, or are there other mineral imbalances? Can they absorb foods and nutrients in the first place, or is there achlohydra, SIBO, SIFO? Are they pooping comfortably? Can they detoxify ….anything? Where can we gently support some detox?
When children are over-treated, they get sick, tired, weak, anxious, fatigued, depressed; they don’t eat right; they can’t play, they’re weepy or more angry, with volatility; they have rashes, fevers, or get every cold and bug more easily. It’s not necessary to go through this. It can be easier, gentler, and work better.
Functional medicine is the way health care is trending. We all want to feel really good, not just live “meh”, without sickness. Kids deserve it too. If your child is not playing, sleeping well, eating well, and enjoying activities they love, take a look at whether these mistakes are in the mix with your functional medicine provider. Re-boot the plan, and your child can feel better.
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.
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’ve helped kids with autism use nutrition supports, including gluten free diets, since 1998.
Some twenty years later, it still isn’t a standard of care to get a thorough nutrition screening with an autism diagnosis, and it definitely should be. It’s crazy that there is any question at all about the efficacy of this tool. But unless your doctor knows how to do the correct lab work up front – and they quite often don’t – you may be doomed to blow it, or not know in the first place how a GF diet may help.
Gluten free diets can be pivotal for autism, if, and this is a big if, you do it right. It can be daunting, so go for professional assessment and guidance, just like you do for any other treatments and supporting therapies. You don’t pick your kids’ psych or seizure meds off the web, or craft your own OT program; why would you do that for a complex nutrition piece? Somehow, many families still design their own medical nutrition intervention, and may miss key pieces.
And no wonder: None of the usual care team members for kids with autism get training in applied nutrition, nutrigenomics, or how to do an autism-specific nutrition assessment (or any nutrition assessment). Who do you ask? Neurologists, psychiatrists, developmental pediatricians, occupational therapists, feeding therapists, and behavior therapists are not nutritionists or dietitians. Even many dietitians and gastroenterologists in hospital settings, per feedback from my client families, don’t know what to tell families about this intervention. If they’re not telling you to explore nutrition intervention for a child with autism, it’s not because there’s “no proof” that it helps. It’s because they probably don’t know any better.
There’s no shortage of opinions and (poorly designed) studies touting that a gluten free diet, or nutrition support in general, is not a worthwhile measure for kids with autism. Much of this science is just plain badly done. Nutrition is not easy to research, because we’re talking dozens of moving parts: Vitamins, minerals, calories, protein sources, gut metabolome, gut micro biome, developmental status, food allergies and sensitivities, iron status, methylation impairments, mitochondrial disorders, and growth status to name just a few. Controlling all these variables is difficult. Most studies I’ve read about autism and nutrition simply don’t control or evaluate these variables very well, if at all. Here’s one bad example that got wide press, and another, here.
If you want to try gluten free diet, here’s a few tips below. I also strongly encourage you to read this book for details on how to get started, how to avoid pit falls, how to engage your care team, and much more.
- Get a blood test for anti-gliadin IgG antibody (not a celiac blood test) with your pediatrician or gastroenterologist. This will tell you if your child’s immune system reacts to gluten in a way that has potential to affect the brain.
- See this book to learn about other key lab screenings before you begin.
- You will have to eliminate all dairy and soy protein sources from your child’s diet as well as gluten. See this book to learn how, and why. If you don’t, you will not see much if any improvement from eliminating gluten alone.
- Get help with recipes, cooking, and shopping. I help families navigate this. There is a gluten, dairy, and soy free solution for just about everything your child is eating now.
- Many parents don’t realize that dairy food includes yogurt, any cheese from a cow (cream cheese, Parmesan, mozzarella, etc), butter, cream, buttermilk, kefir, raw milk, goat milk/yogurt/cheeses, lactose free milk products, ice cream, sherbet, cream soups or chowders, many sauces and dressings (Ranch), and any processed foods or baked goods that contain any milk ingredients. All of that has got to go, for a successful gluten free trial. If you’re breastfeeding an older child (over age two or three years), even that milk source may arrest progress with this intervention.
- You will have to replace all foods removed with foods of equal or higher nutritional value. If your child relies on dairy protein all day, you will have to work through measures to bust this picky pattern, and find different proteins. Read this book on milk-addicted kids for more help.
- Fix other nutrition deficits, especially weak iron status, which is common with undiagnosed gluten sensitivity. Have your doctor check your child’s ferritin level; it should be in a functional range of 40-60 (lab range will be reported as “normal” when ferritin is as low as 10. This may be “normal” but it is not healthy.)
- Fix your child’s gut micro biome; assess it professionally, and have your provider guide you to optimize absorption and elimination. Your child may need supports like digestive enzymes, probiotics, or herbal tools. I provide screening with stool tests in my practice as well as detailed guidance on how to use corrective supports.
If you haven’t yet engaged a comprehensive nutrition intervention for your child with autism, let’s talk! For many children, when done thoroughly, and with compliance on your part, you may be surprised at how your child’s functioning can improve.