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.
This will make a lot of people mad:
Feeding clinic may be a waste of time and money
Not at all to diminish the important work and skills of occupational and physical therapists. They work hard at helping kids learn to chew, swallow, touch, and tolerate the act of eating – kids who are tube fed, kids who’ve never mastered chewing by age four or six years, kids who only drink but can’t eat, kids who gag and vomit to different food textures, kids who stop eating at the slightest interruption or sudden sound, kids who are in growth failure because they can’t eat. This is important work.
But there are important underlying triggers for these feeding problems to rule out and repair, before you spend thousands on sessions in which you sit behind a two way mirror and watch your child try to touch whipped cream, corn chips, and broccoli with peers, before the rigorous home sensory protocols before each meal (trampoline, Nuk massage, Wilbarger protocol), not to mention stringent food routines at the table.
If your child has had a traumatic brain injury, a spinal cord injury, began life on a feeding tube, or has a physical or developmental disability that impedes feeding skills, then of course rehabilitative therapy is in order.
And, after you’ve been through challenges unimaginable when you became pregnant – that is, the challenge of your kid actually not being able to eat, gain, and grow – and your child has suffered, you’ve been to every specialist, and you know your local children’s hospital hallways backwards and forwards, it can feel downright offensive, insulting even, that there may be something simple, overlooked, that could fix this. Wouldn’t your team have told you?
A lot of parents get stuck right there. They outright reject that a solution as simple as correcting nutrition and digestion first could be a thing. Unless this is a complex, inscrutable drama that requires ivory tower specialist care, and week after week with an occupational therapist, a lot of folks feel like bad parents. So they turn away from the simple.
Forgive yourself for not knowing. Forgive your care team. Occupational therapists, GI doctors, and even pediatricians are not nutritionists. This isn’t their purview. If they had known, they would have told you, of course!
For kids who go from infancy to preschool with a mysterious lack of progression for feeding skills, screen for underlying physiological triggers that can keep your child from being able to swallow, chew, and eat normally. Even for kids with physical disabilities and complex conditions who benefit from feeding therapy, footwork on these underlying interlopers can make eating work even better.
Also, know this: I had one of these kids. Been through it, seen it, worked with OTs and PTs (some fabulous, others not so much). I know the trauma, cost, and stress that accompanies this situation. And, yet another mom just left my office today, telling me with deep exasperation what a waste of time (and money – thousands of dollars, not covered by insurance) it was to send her young son to a renown feeding clinic, for months, carefully following instructions for the home plan too, only to get feeble progress out of it at all. Is this you?
Before you go through costly, strenuous therapy that may inch your child forward, but not quite produce the progress your child deserves to grow, thrive, and just plain enjoy food – investigate these problems. Your child will be healthier, because they will be able to digest and absorb food more comfortably.
Nutrition and digestive problems turn kids into picky eaters
Fix these, and their appetites can quite abruptly improve. If you need help fixing these, schedule an appointment with me. You may see changes in as fast three to four weeks, depending on your child’s condition at start, and your compliance with a nutrition and gut health care plan tailored to your child. Here we go:
1 – Fungal Dsybiosis: Your child may have had thrush, you may have had a C section, maybe there were antibiotics in the mix for you while pregnant or breastfeeding, maybe you have a lot of yeast infections in your past, or maybe your child needed antibiotics early, often, or both. Whatever. Somehow, your child may have been left with a fungal burden somewhere in the digestive tract. What this does is (a) buffer the stomach so it is less acid, which makes you never feel that hungry (b) constipate you so you never feel like eating because you are always full of ______ (c) give you serious cravings for very few foods, namely, starchy sweet stuff, or dairy food and (d) bloat your belly. Solution: Screen for fungal dysbiosis with stool or urine testing; ideally include Candida and Saccharomyces antibody testing too (blood tests). Give a protocol to drop the fungal burden and restore healthy gut bacteria balance. Your kid will feel more hungry, poop more regularly, and will want new foods, usually in about 3-4 weeks. Other nutrition measures may be needed, but this is a foundational piece that can relentlessly dog kids’ appetites. Note: Probiotics can help, sort of. The stuff on store shelves is usually too low potency to make a dent for kids who truly have a significant fungal burden in the gut. If you’ve used them and your kid is still picky, they’re not working, and you need a deeper strategy.
2 – Bacterial Dysbiosis: Your child may have a bacterial imbalance in the stomach, upper small intestine, or colon. This can make eating very uncomfortable. The small intestine normally harbors little bacteria; when too much is there, kids can have a lot of trouble eating. This will continue until these infections are treated. This is called Small Intestine Bacterial Overgrowth (SIBO), and your doctor may need to prescribe antibiotics to treat it. Some herbal treatments work well also; probiotics can make it worse. Kids with bacterial dysbiosis feel full quickly. They may gag, or vomit violently, even to the point of shock (they go limp, become pale, you may have even rushed them to the ER where they needed IV fluids – this is FPIES) if they eat the wrong foods. Pressing children to eat when an infection is active in the gut is truly unnecessary and will be unsuccessful too. Solution: Talk with your GI doctor or pediatrician about possible SIBO. And, do functional stool testing such as GI MAP (one of the tests I use in my practice) to identify what microbes may be interfering. This test can give detail on what your child needs to balance bacteria in the digestive tract, so they can eat and digest food more normally.
3 – Reflux Medications: These drugs, which are not approved for use in children by the way (with one exception), diminish digestion by reducing acid in the stomach. Great for an initial reprieve from what may (or may not) be a painful reflux, but bad longer term. The more stomach acid is reduced, the less your child is able to digest food, and the more food will sit in the stomach and – you guessed it – reflux up to the throat. Many kids in my practice end up on highest allowable doses of these drugs, but still have feeding problems with weak appetites and texture aversions. Reflux medicines also exacerbate fungal infections in the digestive tract, creating even more dysbiosis and difficulty with feeding and eliminating. Solution: Unless your child needs “mercy” dosing of a reflux medicine to ease pain, talk to your doctor about weaning off of it. For more help with that process, check this blog and contact me for an appointment.
4 – Weak Iron and Zinc Status: These minerals have a lot to do with what we feel like putting in our mouths. Even adults with poor iron or zinc status will do weird things like hang around, sniff, or even lick gas pumps, chew on paperclips, or refuse to eat vegetables. If your child is mouthing objects beyond early toddlerhood, or insists on eating non food items into school age years, it’s time to straighten this out. It could help normalize eating “behavior”. Solution: Have your pediatrician run labs for ferritin, serum iron, transferrin, iron binding capacity, and serum zinc. These should be solidly in the middle of the lab range – not near either end. If these labs come back looking a little weak, get guidance on supplementing these minerals. Iron and zinc won’t be well absorbed, by the way, if your child takes a reflux medicine – so this is another reason to get off that stuff. It reduces absorption of minerals and B vitamins. Not what your child’s developing brain needs.
5 – Opiates: Wow, what WHAT? Yes, your kid might just be a little high on opiates all day long. Common signs: Do they wake up from 1 to 3 AM all silly or active? Are they constipated? Do they have a crazy voracious appetite and a big head (above 90th percentile)? Are they verbally delayed? Do they bang into stuff and never cry about it? Do they really, really seek proprioceptive input, to the point of endangering themselves? Are they hyper? Do they meltdown fiercely when hungry, or if you don’t hand over that favorite mac and cheese, yogurt, or noodles and butter STAT? Addictive, opiate-like neuropeptides can form from wheat, dairy, and soy protein in a gut with certain digestive impairments. This will make a child relentlessly, extremely, fiercely picky for wheat and dairy food (maybe a little soy too). Yes, food proteins can be misappropriated into compounds that look like opiates to the brain. This happens when digestion is weak and the gut is too permissive; that is, the intestinal wall lets bigger-than-it-should molecules across into circulation, something a healthy intestine won’t do. These opiate-like compounds have various names: Dietary peptides, polypeptides, casomorphin, gliadorphin, or exogenous opiates. Urine screening is available to identify these. These will cause a lot of problems, including stunted language development, social delay, some crazy, even violent or aggressive behavior – and, uber picky eating. Feeding clinic will go nowhere if your child is swimming in opiate like peptides from milk, yogurt, Pediasure, bread, pudding, crackers – any wheat or dairy food. It’s all your child will want to eat, and anything that looks or feels different will be a non-starter. Solution: Start with my e book on milk addicted kids. If you need help getting your child out of this hole, set up an appointment to get started. Your child may need a strict gluten, casein/dairy and soy free diet (the prime opiate offender foods).
Get your kids clear of these five physiological problems and you may be amazed at how swiftly they graduate out of feeding clinic. Ignore any one of them and it is going to be a longer haul. Check out my quick video recap, click here. Thank you for stopping by.