Getting your kids’ annual physicals this month? Take this check list with you to your appointment. There are straight forward, nutrition-focused solutions to all of the problems on this list. No drugs, no therapy, no ongoing visits to behavior clinics. Simple measures may resolve these problems without drawn out drug trials or therapies that leave your family frustrated and exhausted. If your pediatrician is stumped about how to use real food and nutrition tools, let’s talk soon!
1 – Diarrhea is not a developmental phase
How often have I heard, “my doctor said it’s ‘toddler diarrhea'” or “Clostridia difficile is common in kids, it doesn’t need treatment” or “it’s okay because my kid is still growing” or “it’s because he has FPIES“. Yes, infants and toddlers have varying stool patterns, but there is usually a reason for it that can be fixed. And it should be, because chronic diarrhea robs your child’s brain and body of critical nutrition. Teething, fevers, and stomach bugs can disrupt potty pattern for sure, but the operative word here is transient. Funky poop should resolve back to a comfortable pattern within a few days or a two weeks at most. Expect a baseline pattern of formed (not hard, not dry) stools every day that are easy to pass. Ongoing loose, explosive, mucousy, irritable, burning, or foul stool is not healthy, normal, or necessary to put up with. It is a sign that something is awry – food intolerances or allergies, background infections, reflux, or weak nutrition status to name a few. It can also make it harder for kids to potty train, when they never know what’s coming!
The other clear sign for good digestion and nutrient absorption in kids is steady growth pattern, with no flattening trend for weight, height, or body mass index. Daily eliminations that are soft formed (or soft gold mush for breast fed babies) are a sign that your child is digesting and absorbing his food well (in ancient Ayurvedic medical traditions, anything less than a soft formed elimination after each meal is considered constipation!).
Kids who have chronic diarrhea also often exhibit what can be misconstrued (and fruitlessly treated) as behavior or psychiatric problems like anxiety, irritability, low motivation (fatigue), bad sleep patterns, or inattention. What I so often find is that once digestion and stool pattern are supported, these problems fade too, as kids absorb nutrients and energy more reliably. Who wouldn’t feel better?
Long short – if you have a cranky little who can’t sleep well and who has a lot of loose messy stools, investigate. Don’t mask symptoms with long term drug dependence – fix the underlying problem. Your child’s gut health can likely improve with non-drug, nutrition-focused measures… even with conditions like FPIES. And if your school aged child is struggling with chronic loose stools, fatigue, and poor energy, expect it to be better. If your pediatrician can’t help, and a gastroenterology referral was a dead end too, schedule an appointment for integrative nutrition with me today.
2 – The most important thing for fighting infections is strong nutrition
Forget the vaccine debate. Nutrition status is the single most critical factor (of the “greatest public health importance“) to influence whether kids get sick, how often, for how long, and whether or not they have complications with illnesses or infections.When kids do get sick with serious bugs like flu or measles, well nourished kids fare far better, with a less complicated, shorter course of illness and full recovery. For over seventy years, data have piled up to show what a huge impact nutrition has on the immune system, from several angles – from your kids’ tissue stores of vitamin A, to total protein intake, growth status, iron or zinc status, inflammatory chemistry, and more! You can help your kids stay well even as they are surrounded by sniffles and coughs at daycare or school, by setting them up with tip top gut health and food. Judicious use of supplements, probiotics, and herbs can work wonders too – just be sure to tailor these to what your child needs, not a one-size-fits-all approach. Music to my ears: When parents whom I’ve worked with tell me, “We didn’t have any colds this whole winter!” It happens.
So what is nutrition status? It isn’t what supplements you’re eating, whether you’re vegan or Paleo, or even what food you give your kids. It’s a number of things that are classically measured in children to assess how healthy they really are. These are not all included in a standard well check or school physical, but some may be added on if you ask your doctor. Strong nutrition status is evident in:
- Solid growth pattern in your child’s expected channels for weight, height, and body mass index. Your child can be expected to proceed at percentiles achieved at birth, unless s/he had a special circumstance that needed support very early, such as low birth weight or premature birth; even this can be expected to improve some as your child grows. Though pediatricians generally won’t address growth regression until children fall way down the chart, drops of more than fifteen percentile points that persist for more than three months warrant investigation for cause.
- Mid range lab findings for serum iron and ferritin (not at high or low edge of the range); normal blood count; normal chemistry panel with serum protein, albumen and other findings in mid lab range.
- Infrequent illnesses with short duration and full recovery.
- Strong clinical signs for healthy hair, skin, teeth, and nails; no or few cavities in the child’s lifetime.
- Ability to play, sleep, learn, and eliminate comfortably.
3 – Your child may need iron when s/he is not anemic
It’s common at annual physicals to check hemoglobin and hematocrit for kids, which is done with a finger stick blood test. These are two tests to check if your child is anemic. The problem with this is that these are low sensitivity tests that don’t pick up pre-anemia. Pre-anemia is a thing! It is a state in which iron stores are depleted, but hemoglobin and hematocrit are still in the normal range. These kids need iron support, and depending on diet, food intake and other factors, the fix may be just the right food, or may require the right iron supplement (there are several) or even an iron prescription. Kids in pre-anemia will have any or all of these features:
- shiners under eyes, pallor
- more frequent infections and colds; may take longer to recover
- irritable; crabby one minute, happy the next
- hyperactivity with fatigue – “crash and burn” pattern
- math may be most difficult subject (iron is related to math learning!)
- difficult sleep pattern, insomnia, can’t settle to sleep or sleep through
- picky or weak appetite; may want to chew non food items
- in girls in puberty, menstrual flow may be heavy, fatiguing, and/or with clots
Since iron is poisonous as well as essential to our bodies, don’t give iron supplements without guidance. Request thorough testing to find out if your child needs iron, vitamin B12, protein, or just the right food to correct anemia. I can help you with this as well, by finding an easy to tolerate iron supplement or B12 protocol, as well as how to work in replenishing foods.
4 – That allergist referral won’t find all your kids’ food reactions
Allergists check one thing: Allergies. They look for reactions by checking IgE (immunoglobulin E) responses to foods or other substances. They may measure histamine and tryptase levels too, among other things that relate to those swift and dangerous reactions that have you grabbing the Epi Pen. But there are many other types of reactions to foods that disrupt stools, skin, behavior, and functioning. If allergy testing was negative for your child, but there are frequent colds or congestion, asthma, eczema, messy irritable stools, weak picky eating, or other nebulous symptoms, assess more deeply. So far, while insurance coverage for food allergy testing is common, it is not common for testing for food sensitivity reactions, or other immune responses to foods. Identifying these can make life a whole lot better for kids struggling with multiple symptoms – but, be prepared to go out of network and possibly pay out of pocket for these tests. Depending on your insurance and your child’s nutrition diagnosis, it may or may not be covered. I guide parents with this testing, can authorize it if your doctor does not know how, and interpret findings to build a nourishing diet for your kids.
5 – Nutrition CAN reduce ADHD symptoms without medication
Big topic. Pediatricians are trained to offer behavior therapy as a first line of intervention for young children with ADHD; if that doesn’t work, their next recommendation is for medication with behavior therapy. But what they don’t learn is how to help children achieve functional focus with nutrition, gut health, and food. So much can be done! Stimulant medications have many drawbacks and side effects. Search my blog posts on nutrition and ADHD – there is ample to mine there. You can also view this free lecture on nutrition and ADHD.
Children as young as three years old can be given stimulant medication, per FDA guidelines. It may seem like an easy quick fix, but there are other options. This is not without costs to your child’s health and well being; suicidality may increase in older kids given these medications. Help your child eat and absorb the nutrients his brain needs to focus. Take out the toxins, inflammation, and noise in the body. You may be amazed at the difference nutrition care can make.
Why doesn’t my doctor practice nutrition?
Pediatricians don’t have a lot of time when they meet with you for a school physical or well check; insurance companies tightly control what topics can be addressed in those visits, how long the visit can take, and how much a doctor is paid for that service. When your pediatrician wanders from the format, he essentially won’t get paid for his time. And, they need to have a high volume practice to make money – meaning even less time to listen to you, educate you on meals and nutrition, or research new topics on their own. Further discouraging nutrition in pediatrics is that drugs are much more profitable. Drug companies now wield heavy influence over pediatric care, from the time a doctor begins medical training to every week in practice, when drug company sales reps visit with samples, glossy brochures, pens, free lunches, treats, or incentives to write prescriptions. It’s irresistible and easy. There is no such format for nutrition intervention for complex problems. Last but not least, pediatricians are not required to complete much training in nutrition. They simply may not know what to do.
In my nutrition practice, I give clients lengthy appointments to integrate all facets of your child’s care into an individualized nutrition care plan, including lab studies, history, growth status, food intake, and aspects of your lifestyle. I write detailed care plans for each encounter. This takes a lot of time that pediatricians don’t have. If you’re stuck, get started today with an appointment. Or go to my home page (scroll down) to download your free Sensory Nutrition Checklist – begin today with some easy tricks to help your kids function better!
I’m now serving my second generation of clients, working with moms who where were not even born when I finalized my credentials as a dietitian/nutritionist. Recently I did a double take noticing that a young mom I was working with was born on my wedding day – Wow!
It has been quite a journey. I’ve watched earlier clients’ kids, and my own son, grow up to be more functional and able, after rocky and uncertain beginnings. But I have some bad news for you young moms: It is a lot worse out there than it used to be. It’s very different for you than it was for my generation. There’s a whole new normal, and it ain’t pretty.
More than half of US children are now chronically sick or disabled – meaning that it is now more common for kids to have chronic conditions or developmental delays, than it is for them to be healthy, growing strong, and developing or learning normally.
During my graduate years in public health nutrition, this was unthinkable. CDC goals we worked with then have not come close to being met. We’ve not only fallen short, we’ve actually violated the very first goal to “prevent morbidity and disability “- ! Both have increased dramatically for US children in the 21st century.
Type 1 diabetes has quadrupled. Children under age 10 are now getting diagnosed with Type 2 diabetes – actually unheard of when I was trained in the late 1980s; this was only diagnosed in overweight, middle-aged people at that time. At least 80,000 kids in the US are diagnosed with Crohn’s disease, a severe and chronic inflammatory bowel disease, and its incidence in children is increasing. I meet kids each month who have similar symptoms but have never been diagnosed, and I just worked with my first toddler diagnosed with Crohn’s disease this spring. During my training, this wasn’t even mentioned as a condition that a young child could have. Even the phrase “toddler diarrhea” didn’t exist (diarrhea is not a developmental phase!). Babies and toddlers were not diagnosed with, or given medications for, GERD (reflux drugs like Nexium came to be so overprescribed, they were called “purple crack“). Asthma, cancer, allergies, and of course – autism – are all increased far past their 1985 levels, with no signs of slowing down. And are you tired of hearing yet that autism has shot up nearly 150-fold since 1975, and that some estimate that half of US children will have it by 2025? How will this country function, populated by sick and disabled adults? How will we pay for their care?
Those are big questions. But here is the question that has had me scratching my head for the last twenty years: What are our pediatricians doing about it?
Are they even thinking about reversing these trends, in any meaningful way?
If they are as young as you are, it’s doubtful they know how miserably we failed at reaching the CDC’s goals from the late 20th century, for population health. Or that they’ve had much of a deep dive into child nutrition and its role in development, learning, behavior, and immune strength. I also do wonder if they know what it’s like to see kids who never need any prescription drugs, because they’re just …healthy.
Being sick repeatedly throughout the year, needing multiple rounds of antibiotics, being developmentally delayed, having an impacted, inflamed, or ulcerated colon, being unable to eat anything but milk, yogurt, or Pediasure, or having only loose, burning, foul stool or impacted hard stool may be common nowadays, but it isn’t normal.
Your kids should be healthy, comfortable, vibrant, eating, eliminating daily, sleeping well, growing, playing, and thriving! If they can’t because of a chronic condition, then they still deserve to reach their fullest potential, enjoy their highest well being, and feel good as often as possible.
From my perch as a pediatric nutritionist/dietitian, I have watched it get harder and harder to restore kids’ health, away from the chronic gastrointestinal, feeding, growth, developmental, and allergy/immune problems they have. Kids bodies seem more compromised, their immune systems more confused, their intestines less functional. The work is more complex than it was in 1998 or 2000. Diagnoses like FPIES (which my own son had in 1996, before there was a name for it), milk protein intolerance, food allergies, intolerance to breast milk, and EoE are not unusual now, but they earned no mention during my training in infant and child nutrition in the late 1980s.
I often wonder how pediatricians of my generation reconcile this. Do they notice, like me, that children are sicker, as government data show?
Moms under 35 have it rough. You are..
- The first generation to grow up with more antibiotics, vaccine doses, psychiatric medicines, and just plain more prescription drugs than any other.
- The first generation to grow up eating GMO foods.
- In the years you were conceived, patent and marketing laws for drugs changed – and dozens of new drugs flooded the market, whether we needed them or not, and regardless of non-drug options that may have worked as well or better.
- The goal posts have moved for what counts as valid published medical “science” – much of it is now ghost written by the pharmaceutical industry.
- Environmental protection laws are either being stripped or unenforced, allowing more toxins into air, water, and food.
- You are now bearing children with more toxic burden than any parents before you in America’s history.
In short: It’s a lot harder to have healthy kids these days. Your bodies were exposed to more toxins, sooner, than people of my age. And now your children are exposed to all of this even before they’re born, in utero.
So now what? It’s simple: Remember that your kids get to be healthy.
That is their birthright, and their normal. Expect them to be healthy, not chronically sick. But you have to do some serious footwork, even before pregnancy, to help them get there. If your kids are already here on the planet, there is a lot you can do to diminish their odds for chronic disease, developmental injury, and psychiatric conditions. If your kids are already affected by these problems, there is still plenty to do with food, nutrition, and good support for immune function and detoxification – you might be surprised to see how well your kids can be.
Here you go:
- Eat organic whenever you can. It matters. I actually did some work on this during my graduate studies (eons ago) and found that yes, organic foods are more nutritious, and have fewer toxins (though not toxin free, thanks to widespread use of pesticides and GMO crops in the US).
- Don’t eat GMO food, period. Minimize it as much as possible. Here’s why.
- Find out if your kids have food sensitivities or allergies; feed them foods that nourish deeply, not foods that chronically inflame.
- If your kids need antibiotics, restore healthy flora – you will know it worked by appearance of a daily, comfortable elimination (no bloat, hiccups, burps, picky eating, straining, watery stuff, mucus, dry pebbles, or foul odor – just formed easy to pass stool and healthy appetite).
- Drink filtered water, not tap water. Put filters on shower heads. Or, consider a whole house reverse osmosis water filter.
- Don’t use plastic containers for food. Avoid plastics, xenoestrogens, and xenobiotics in lotions, shampoos, soaps, or foods.
- Eat more vegetables, more plant foods, and less meat and sugar than you want.
- Eat loads of ancestral, organic fats and oils.
- Don’t have a C section if you can help it. If you can’t, seed your baby’s gut biome with probiotics or your own flora.
- Don’t get vaccinated while pregnant. It can increase your risk of miscarriage, and it delivers toxins like aluminum, mercury, and rogue viral or human DNA into your body. Effects of vaccinating pregnant women on their unborn children for asthma, allergies, or other immune mediated conditions are unstudied.
- If you need antibiotics during pregnancy, delivery, or breastfeeding, take all precautions to restore your baby’s gut flora with probiotics and a healthy diet.
- Read this 2017 study on the health of vaccinated versus unvaccinated kids. Choose soberly what you want to do.
Those are good starts – a big effort, yes; harder perhaps, but the upstream work is well worth it if there is a chance it can prevent burdensome chronic conditions in your kids. If you need more specific guidance for your own child’s situation, contact me for an appointment and we can get started.
Has anyone on your child’s care team done lab tests, only to tell you they’re all “normal” and there is nothing more to do? Or worse, you’re sent to a specialist for more tests and invasive procedures, when you still don’t understand what is going on?
This is such a common story in my pediatric nutrition practice that I had to address it. The truth is that any lab test result has two interpretations: Lab range, and functional range. Anyone, including babies and kids, can have test results that fall within the lab reference range (considered “normal”), when they are in fact teetering on health disasters. Functional range means your lab test results fall into a more narrow range, and this is where you actually feel good. You’re not just not sick, you’re well!
If your pediatrician is using only lab range to interpret your child’s results, then a lot of opportunity for well-being is missed. And, you may end up doing more invasive and useless diagnostics, when improving these initial findings is all that your child might need.
Establishing what is considered “normal” ranges for lab test results is difficult to do. Groups of individuals who have no known health problems are tested, and a range is created from their findings, for each lab test that exists. These ranges can be wide. But functional lab test results fall smack in the middle of the lab reference range. The lab range is wider than this, and may include findings for people who are not so healthy. This is why it’s good to look closely at your child’s findings and ask questions.
Here’s what to do:
- Always get a copy of your child’s labs, after any visit where your doctor presents them, including emergency room visits. Keep these in an organized file.
- Use your doctor’s secure on line portal (if they have one) to view your child’s labs. Download these and save them as pdfs if you like, so you can carry these into other provider visits with you, and get second opinions.
- Scrutinize your child’s lab test results yourself. If you notice results that are close to being out of range, ask your doctor about this.
- Don’t assume your primary care doctor or pediatrician always or immediately sees lab test findings done in an emergency room visit, or at a specialist visit. Always maintain your own files of these and share other providers’ test results with your pediatrician or primary care provider.
Some typical examples of “lab range” problems from my practice…
- Gluten sensitivity may bet the most frequently missed diagnosis I see. Many doctors run celiac panels, which can be normal, even when a child has a gluten reaction. The problem here is that many celiac panels do not check for gluten reactions – they only check for celiac serology. It’s possible to have debilitating reactions to gluten, without having celiac disease. This is called non-celiac gluten sensitivity and it can really wreck your kid! Definitely get a second opinion if your child continues to grow poorly, have stomachaches or headaches, or experiences ongoing gut or even psychiatric symptoms.
- Iron and Anemia Screening: You may have seen a normal hemoglobin and hematocrit at your child’s annual physical, but this can miss other problems concerning iron. The hemoglobin and hematocrit test is done with a finger prick drop of blood. This will only fall out of lab range if your child has entrenched anemia. Read this blog on iron screening to learn what to do next – prevent complications from marginal iron status that don’t show up with the fingerstick test.
- Ferritin (the storage protein for iron) has a very wide lab range, and labs vary on how they report it. Some labs report a ferritin level as low as 10 as normal; others say it’s okay for it to be as high as 400. Either way, ferritin is so important for your child’s immune function, learning, behavior, sleep and more that more investigating is worthwhile if this lab finding is not somewhere between 40-85.
- White blood cells (WBC) fight infection, and the lab range may sound small: Anywhere from 4.0 to 14.0 for kids is considered “normal”. But if your child’s WBC count jumps from its usual level of 5 or 6, to say 11 or 12, then it’s possible your child is fighting a new infection – even though it’s still “in range”. Or if it always hovers at the low end, say 3.8 to 4.0, then your child may have an undetected chronic infection that keeps him tired, cranky, or inattentive. Is your child having any fevers, intermittent malaise, frequent colds and bugs, tired all the time, unable to shake off a cold or virus? Go back to your doc and ask about it. By scrutinizing the blood count further, your doctor can discern if your child is fighting a bacterial infection, a virus, or struggling with a moldy environment, and may be able to help you more.
- Vitamin B12 can be a red herring if it your child’s serum level is reported above range. This may mean B12 is hanging out in serum instead of getting into red blood cells, where it is needed, so those cells can function normally with normal size and shape. Further scrutiny of a complete blood count will show if B12 is needed, as will a test called methylmalonic acid. Serum B12 level alone can’t give the whole picture. Simple changes in nutrition protocols can fix this.
- Lyme disease antibody may report as a false negative if your child got exposed to this infection long ago and you didn’t know. If Lyme disease is at all suspected, ask your doctor to be as thorough as possible. Do both the Lyme antibody test, as well as all the “reflex bands” and a co-infection panel. Undiagnosed, old Lyme infections can impair immune response to other infections, so the co-infection screening is important.
- Blood tests for heavy metals are not terribly useful. Blood tests can “see” recent or active exposures to heavy metals, but won’t show you about past or old exposures. If your child’s mercury or arsenic screening came back ok, this doesn’t show whether or not those metals are hiding out in places they really like – like kidney, brain, or nerve tissue. Mercury, lead, arsenic and other heavy metals like to avoid watery spaces (like blood) and migrate to fatty tissues, where they tend to stay put. If you really want to know about heavy metals in your child, some other tools are necessary.
These are just a few examples of how your doctor might miss opportunities to really help your kids feel good. If you have questions, always ask. I maintain continuing education credits in functional blood chemistry, and enjoy helping families with using nutrition supports to help kids feel really well. Make an appointment with me today if you need extra help!
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No matter where you look, ADHD is everywhere. Can nutrition help? Kids as young as two years old routinely receive stimulant medication for it. According to CDC data, kids on Medicaid – that is, kids in poorer families – are more than twice as likely to get medication for ADHD than kids whose families have employer-sponsored insurance.
That’s no coincidence. Families in poverty eat poorly. They may live in food deserts, where fresh nutritious food is simply not available. Or, they may have no car (how do you get a week’s worth of food home without a car?), or no kitchen. Plainly, these are the kids whose brains will suffer most from outright malnutrition.
But what about families with means? With cars, kitchens, Whole Foods markets, and health insurance? Why are so many of their kids presenting with ADHD symptoms too?
Because: Your child can be eating well, and even eating a lot, and still have one or more of these sure-fire nutrition fails that can trigger ADHD features. Leave any of these unaddressed, and it can be an uphill climb, whether you decide to medicate or not.
1 – Fungal body burden and gut dysbiosis – Especially for kids with big appetites for sweets, starchy processed foods, lots of bread, pasta, or dairy food.. but little else (hates veggies, hates proteins), this is a biggie. Optimize your child’s gut biome, and you will be amazed at the changes you will see in behavior, mood, attention, distractibility, and focus. “Fungal load” isn’t considered problematic in mainstream pediatrics, but it takes center stage in functional nutrition and functional medicine practice. Unless a child has visible thrush coming out of a body orifice, obvious ringworm style rashes, or other visible fungal skin manifestations, you’re probably not going to get traction on this one at the pediatrician’s office (but you will get an Adderall prescription). A functional stool culture to screen for fungal load and check levels of adequate beneficial flora is a start, and there are many other lab tests to define this piece. Depending on findings, I will choose a combination of herbal supports, probiotics, and foods to correct this. Correcting this piece can balance blood sugar swings your child may experience throughout the day, as well as eradicate irritating toxic by-products of a fungal-heavy biome. The result is a calmer, happier, more focused kid.
2 – Weak iron status – Iron is deal breaker for attention, focus, mood, sleep pattern, and appetite regulation. We need it to oxygenate the brain of course, but we also need it to create and balance neurotransmitters for learning. Kids don’t have to be anemic for weak iron to create or worsen ADHD features. Kids who have anemia (more common than you might think) are easy to spot. They are tired, with pale skin or dark circles under their eyes. They sleep more and are visibly fatigued. They get sick more often, and stay sick longer. Your pediatrician is likely to pick up on this obvious problem with a simple finger prick blood test for hemoglobin and hematocrit. These only fall below normal levels when a child is well entrenched in iron-deficient anemia.
But there is a big grey zone between anemia and solid, healthy iron status. It’s called pre-anemia. That’s where kids may not look anemic, but will have distractibility, irritable moods, impulsivity, insomnia or broken restless sleep, and poor school performance, especially for math tasks. They may have bounds of energy part of the day, then get flat tires later on. More detailed testing than your pediatrician’s finger stick for hemoglobin and hematocrit are needed to sort this out. Learn more about the iron-ADHD connection here.
3 – Fish oils: You’re Doing It Wrong – Tomes have been written about what fish oils, and specifically omega three fatty acids, do for the brain, and about how our diets have changed over the last half century to deprive us of them. Fish oil supplements are widely available to help address this, but the trick is in the dosage and in the form. Many families I meet in my office use too low a dose, or use the wrong combination of oils for their child’s needs.
For kids with inattentive, incomplete, or stilted effort when it comes to writing, reading, and visual tracking, emphasize DHA omega 3 fatty acids, and give 400 to 800 mg daily; more may benefit in some cases. Supplements that only give 50-200 mg DHA are of little value for ADHD or dyslexia. Nordic Berries DHA might be fine for kids who don’t have attention or learning problems, but they don’t come close to providing a therapeutic amount of DHA for kids with ADHD. For kids with impulsivity, emphasize EPA omega 3 fatty acids, and give 2000-4000 mg daily (two to four grams).
Liquids often work better than pills here; pills are large and often too numerous to take, to meet a relevant dose. Many products combine DHA and EPA omega three fatty acids into one dose. My preferred products (based on kids’ acceptability, dose, ease of use, and palatability) are Barlean’s Ultra High Key Lime Omega Swirl or Pharmax Finest Pure Fish Oil, but there are many others. Avoid sugary gummy chewable versions of DHA supplements, which tend to have more sugar than fish oil in them, and don’t do much good.
Note: Cod liver oil is a different animal altogether, and doesn’t have adequate DHA and EPA in itself to crack ADHD symptoms, unless you begin using doses of a tablespoon or more daily – and for some kids, this is too much because of the high vitamin A content in it. It is fine to combine cod liver oil with other fish oils and it is a great immune boost in itself.
4 – Weak protein – There are many ways protein can go wrong. When it does, it means the brain can’t get the amino acids it needs to build and balance things like dopamine. Amino acids come from protein we eat. Whether it’s too little total protein eaten daily, too much of just one kind of protein (such as, your kid only eats dairy protein), eating inflammatory trigger proteins (undetected food sensitivities or allergies), or protein that is poorly digested or absorbed, kids who don’t get the right balance of amino acids into their brains are going to have “behavior” problems that can manifest as ADHD.
Amino acids are the building blocks of things like dopamine, GABA, serotonin, epinephrine, and all our neurotransmitters. Kids can look strong as an ox, grow well, and have more energy than you can handle – but may still have poor amino acid availability in the brain to build that focus chemistry. Or, they can eat a varied diet, but have chronic inflammation from low grade, undetected food protein sensitivities or allergies. Another problem is a pattern of constipation – always suspect for poor protein digestion and absorption.
There are many ways to sort out what your child’s protein story is, and many ways to fix it once you know what it is. Some kids just need diet changes; some need protein supplements; others need individual amino acids given as blends or as singles, such as tyrosine or carnosine. Still others may only need to improve a constipation pattern with gut biome balancing. Again, you may be astonished to see how easy it is to lessen ADHD features with targeted protein corrections.
5 – Too little food all day, every day – So simple, it’s exasperating. And many of you are probably saying, “…but my child can’t eat during the day at school, he’s too distracted / disorganized!” It is a catch-22, but once it is solved, kids do so much better. There are solutions that can get to the cause of this so that kids can pause and eat better, and they are worth the effort; there is no way a growing child can function smoothly from early in the morning to late afternoon, without eating.
While I work on helping kids’ appetites from the inside out, many of my clients work with school administrators on creating on a small lunch bunch so their kids can eat with a few peers in a quieter spot (a common accommodation in Individual Education Plans or IEPs); or, pack easy-to-swallow, high density liquid nutrition for lunch instead of a bento of items that require some disassembly, utensils, or organization. A formula called Neocate Splash has been helpful for many kids in my practice. Yes, it has some “ick” ingredients, but this product has permitted many of my kid clients to make it through a school year happier and more functional than if they had not had it at lunch – especially those with multiple food sensitivities. Another option is Orgain, an organic version of drinks like Pediasure which is available with or without dairy or soy protein. Orgain is in many supermarkets as well as Costco.
A simple finger food or two with a high-octane liquid lunch like this is better than zero food or a few raw vegetables and cheese. Consider deli meat wrapped around fruit; something to dip in hummus or pesto (crisp bell pepper wedges, crackers with seeds or sprouted grains); jerky or even bacon; or snack bars or bites rich in healthy carbs and fats, like Lara Bites or Lara Bars. Living here in Boulder, Colorado, it seems I see a new organic, kid friendly, hypoallergenic snack product every week in our local stores. If your local stores don’t stock healthy nutrient dense bars or snacks, shop on line – the options are endless, and impressive.
6 – Undiagnosed food sensitivities – These reactions, which are different from food allergy reactions, will definitely niggle your kids’ brain, and keep the distractibility flowing – along with dysgraphia, impulsivity, and slower processing speed. If you’ve done food allergy testing via skin prick or blood draw, you’re not done. Consider an ELISA IgG food antibody panel to find the full story. Cross-reactivity can occur between IgG food reactions and brain tissue – lab tests are also available to scrutinize this too, if helpful. Even if you’ve tried elimination trials, do the test to see what is really going on.
7 – Too few carb calories – We love to demonize carbohydrates these days, but truth is, kids really need them. A balance of healthy carbs in kids’ diets fuels progress on their weight-for-age growth pattern. It also protects protein from being used up for energy during the day – important, because we need that protein to get to the brain for functional focus chemistry. When there are enough carb energy sources around, protein is spared for growth and structure – so your kids can progress on their height-for-age growth pattern. Without carbs, even if your child eats a lot of protein, linear growth (height) can be stunted. Don’t limit your kids for reasonable carbs. Allow hefty ones during the school day with some good protein and fats – pumpkin breads, custard cups, sweet potato chips with guacamole, Paleo treats like Hail Merry Miracle Tarts or Merry Bites, Chia Pods, quinoa or cous cous salads with chopped cooked green or wax beans, olives, and hemp seeds – the options are plentiful!
8 – Not eating organic – Yup, it’s more expensive. But even the American Academy of Pediatrics is on board with this one. If you missed it, a clear association was found between ADHD and agricultural pesticides in urine in children. Per standard operating procedure, the AAP stated that more research is needed to see if this is causal. Wanna wait for that? Your kid will be 25 years old. Play it safe and smart, and splurge on organic when you can; grow your own; get some chickens or barter with neighbors who did; visit your local farmer’s market. Your kids really are what they eat!
9 – Untreated methylation impairments – You may have heard of nutrigenomics, the practice of integrating your genome with food and nutrients. Many things turn genes on and off, from toxins to nutrients. We have genes for everything, from what color eyes we have, to how vitamin D attaches to cells, to how efficiently we make dopamine, yes dopamine – the target neurotransmitter of many drugs for attention and focus. Dopamine depends on a process called methylation, and methylation gene mutations are quite common. They are easy to screen for (with a cheek swab or blood test for some of your DNA) and straightforward to support with methylated forms of certain nutrients. This can improve attention, focus, anxiety, and depression – drug and side effect free.
10 – Thinking any one of these things in itself will fix ADHD – Your kid’s brain is like an engine – lots of moving parts, in terms of what is needed for functional focus biochemistry. Sure, you can change the oil, but what if the timing belt needs adjusting, or the fuel pump is failing? Don’t expect foods and supplements to work like drugs. If you tried just one nutrition approach and it was dismal, revisit the options mentioned here. Though it takes extra work to assess and coordinate all these components, the bonus is your kid will likely feel happier and healthier over all, without a drug dependency that can last well into young adulthood. Long term use of stimulant medications for ADHD has been shown to make no impact at all for academic improvement in boys or girls, and to increase depression in girls, according to this study. But building strong foundational nutrition will serve your kids for years to come.
Need help? Got questions? Set up an appointment via my calendar here. I can’t give treatment advice for your child in this forum, but would be happy to work with you in my pediatric nutrition practice. I look forward to hearing from you!
“We tried that, and gluten free didn’t work. Nothing really changed.”
Parents often bring that mantra into their first visit with me, as we explore nutrition pieces that might improve life for their kids. My next task is to find out exactly what they tried – because there are a lot of ways to fail at this, and it isn’t your fault. It can be complicated. Here’s my Top Five Checklist of “fails” to avoid.
Long and Strong – This one goes without saying, and most parents who come in know this already. Long means three to six months, not three to six weeks. It can take months for circulating antibodies to gluten or gliadin (a fragment of gluten molecules, equally if not more triggering) to drop off the immune system’s radar. As long as those are circulating, they can cause trouble. So, patience! And strong means zero tolerance gluten: No oats or oatmeal (anywhere, including in those “wheat free” cookies and granola bars), no special occasion exceptions (school parties, holidays, birthdays), no processed condiments or foods with wheat derivatives. Any processed food is suspect without label scrutiny first – everything from ice cream to soy sauce to supplements and medications can have gluten in them. Check everything! Start here for info on gluten in medicines or supplements your child may use daily.
Cross Reactivity – One reason why even the strictest gluten free diet can fail – even for someone with celiac disease – is that there may be cross reactivity with other food proteins. That is, the gluten molecules (or fragments of them) look a lot like other food protein molecules to the immune system – et voila! The body is hoodwinked into thinking you just ate gluten when you didn’t, and reacts anyway. This phenomenon is already demonstrated and documented in the scientific literature. The solution in that case? Ask your provider to run a cross sensitivity panel such as Cyrex Labs Array 4 to find out if this is part of the problem. Identify what other foods you might need to eliminate, and go from there.
Other Reactions – Continuing to eat foods that your child reacts to, even without the cross reactions described above, is another common fail. In this case, the immune system may not be confusing other proteins for gluten. It may simply just react to other proteins in and of themselves, and gluten. For example, it’s common for families to try elimination diets in which one food is removed at a time. That food is put back in rotation, and then another food is removed. The problem here is if a child reacts to both foods, neither elimination is going to show much of anything. The solution is to run IgE (allergy) and IgG (sensitivity) food antibody tests for several foods, and prioritize what foods to eliminate based on these findings. I specialize in helping families interpret these lab tests, and in building a healthy strong food intake when there are more than two or three foods to eliminate. You may end up finding that your child’s biggest problem is casein (dairy) or egg protein, not gluten. And while I don’t think gluten grown in the US is a great idea for anyone to eat, if your child feels better when avoiding dairy instead, fine – the idea is to do what helps your kid feel better.
What if kids show strong reactions to many foods? In that case, judicious rotations can work, with prioritized and strict elimination for gluten and perhaps two or three other top offenders; knowing cross reactions can help refine the plan too. Meanwhile, there are many ways to replenish your child with other equally nutritious or even more nutritious foods – ask for help if it’s overwhelming.
Biome Neglect – If there is constipation, diarrhea, bloating, gas, reflux, or picky eating in the mix, going gluten free is often helpful. When it isn’t, your child may need some biome TLC. That is, Tender Loving Care for the gut! Clear out fungal or yeast overload in the gut, along with “commensal” bacteria or microbes that are taking more than they give. We all carry a few pounds of bacteria in our intestines, and we need it. When it’s balanced in our favor, those bacteria and microbes help us digest food, fend off invaders, give us back some vitamins to absorb for ourselves, and they actually communicate with our own immune systems and genes. When it’s skewed against us, a corrupted gut biome can cause painful chronic problems with picky weak appetite, irrepressible cravings for sweets, weak digestion, and sluggish bowels or diarrhea – not to mention mood disorders. Gluten free may fail if this piece is left behind. Get a functional stool culture, and tune up with the right probiotics or other tools to balance this part out. Then try gluten free with a toned up bowel biome environment.
Too Much Restriction – Especially for those picky eaters who love eating lots of starchy processed stuff based on wheat (pizza, bread, bagels, crackers, pasta, pretzels, cookies, noodles, mac and cheese), pulling the gluten can leave you wondering what they’ll eat. It’s a double edged sword that there are loads of good tasting gluten free versions of all those foods: Your child will have plenty to eat, but it won’t be so good for them. Neither is all that stuff when it has gluten in it. Either way, this style of eating usually leaves kids lacking protein, minerals, phytonutrients, antioxidants, vitamins, and healthy fats and oils – all of which are just plain essential. Your kid might grow, a lot, or may even become overweight eating this way. But sleep, behavior, learning, mood, immune strength, and bowel habits may suffer; depression, bloating, constipation, inattention, or anxiety may persist too. Gluten or no, this way of eating isn’t healthy, and your child may not experience much benefit from withdrawing gluten if other foods and nutrients are still missing. The next step is putting back what is missing, while keeping the gluten out. This may mean that your child needs to add protein, fats/oils, or some healthy grain-free carbohydrates from vegetables or fruits, or that some supplements are needed to gain full benefit. Even a deficit of just a hundred calories, day in and day out, can derail a gluten free trial – kids are growing, and need enough to eat every day to keep pistons firing for learning, sleeping well, and playing.
Still have questions? Start here with info on testing for gluten sensitivity versus celiac disease. Hope to hear from you soon!
FPIES – food protein induced enterocolities syndrome – is becoming a frequent presence in my pediatric nutrition practice. There are no prevalence studies for it yet, and it has only recently been recognized with a diagnosis code. FPIES is a debilitating and frightening condition that affects young infants. When the baby eats, there is sudden vomiting and even loss of consciousness, along with watery or mucousy stools, more than the usual crying and discomfort, and poor weight gain. Blood may be seen in stool. The sudden movement of water into the gut, along with complex immune reactions, may cause a hypovolemia (low blood volume) to trigger shock symptoms. Toddlers can be affected too.
My breast-fed son exhibited these very symptoms as a newborn, just days old, in 1996. We were terrified and scrambled for answers. He would take a feeding, then just explode – with all of it coming out of his mouth and nostrils forcefully – and then he would collapse into fleeting unconsciousness. This happened three or four times in his first two weeks. We were offered zero treatment, and zero advice. We were told it was colic and that we were just nervous new parents who were probably exaggerating.
Finally my son ended up in the ER where the only offering was a work up (that failed miserably) for spinal meningitis. No one had a clue, and we were not treated well by the doctors. In fact, this was such a wreckage of a moment for us as new, trusting, and hopeful young parents that it is what galvanized me to redirect my focus as a nutritionist and help others in this frightful dilemma. I knew then this was not ordinary colic; I knew there had to be an inflammatory component, based on my training in infant nutrition (which I later learned few doctors ever get). It horrified me that any other parents or babies would be left to struggle this way. It was isolating for us, as we knew no one experiencing this (no internet!), not to mention painful to navigate the indifference of the medical community.
I breast fed on an extensive elimination diet, and my baby improved – but I was depleted, and didn’t have the skill set I have now to really do this right. Once he was transitioned to a homemade goat milk formula, he did even better, and chubbed up nicely. He began to do more of what babies do: He smiled, gurgled, cooed, chattered, giggled, slept, pooped (more normally), and generally was happier to be here.
Now I hear from parents almost every week who have little ones struggling with this same scenario. They have been given the FPIES diagnosis, but that’s about it. There may have been a few tests done, but little else to help the baby be able to eat normally and grow well. Hypoallergenic formulas, then elemental formulas, are tried. If breast fed, the babies do better when mom is on an elimination diet. But like I was, many of these families have become emotionally and physically depleted. Breastfeeding on a deeply restricted diet is hard, and introducing “safe” foods for the baby is a roller coaster. No one wants to see the baby struggle with FPIES symptoms. If all else fails, it’s on to tube feeding.
There is a huge missing piece here. What the GI community is overlooking so far, when it comes to FPIES, is the baby’s gut biome. Some screening is usually done to make sure there is no outright deadly gut pathogen in there, but that’s all. There is so much to learn about how our gut bacteria support us from birth, but we already know enough to start working with it – there is no need to wait. We know that the immune system is “tutored” by the bacteria that populate the baby’s gut. Babies who lose normal, healthy gut flora (bacteria), for whatever reason, go on to have more inflammatory conditions later in life. And in FPIES, there are clear shifts in the body’s immune cells that show a lot of inflammation is going on in the gut. Tests for kids with FPIES tend to show more eosinophils (white blood cells that are common with allergy or inflammation), more immature white blood cells (this is the body’s attempt to fight fight fight), as well as obvious changes in gut tissue that show inflammation.
What is causing it? Is it food protein? The answer is not clear. Kids with FPIES often have negative food allergy (IgE) test findings. I have found this to be true in my caseload too. When I have looked further for food sensitivity reactions (IgG) in toddlers with FPIES (babies are too young to reliably test for IgG reactions), those are often negative too. While some kids with FPIES show reactivity to dairy or soy protein, they don’t appear to do so more than the general population. And curiously, two of the most common trigger foods in FPIES are not high protein foods at all. They’re starchy foods – rice and oat – foods that are often among the first introduced to babies. So perhaps FPIES isn’t about food proteins after all.
It’s The Biome, Baby! FPIES babies in my practice have shown improvement with efforts to restore expected, healthy gut flora. While GI doctors will conventionally only rule out life threatening gut infections, I use stool microbiology tests to see if the baby has the healthy bacteria needed to develop normal digestion and immune responses in the gut. This testing also screens for fungal species (yeast), because too much yeast in the gut (aka Candida) will disrupt digestion also. And it looks for “commensal” microbes that are not necessarily pathogenic or life threatening, but potentially inflammatory, if there are much more of them than the healthy bacteria babies need.
So far, just as the literature is reporting, I also notice negative food protein reactions in lab testing for FPIES kids. But -and this is where the literature is pretty mum – in my own practice, stool testing for FPIES babies often reveals inadequate helpful flora. Candida species are not a consistent player here so far, but off beat fungal microbes pop up: Saccharomyces cerevisaie (a component of newborn hepatitis B vaccines) or Rhodotorula muculaginosa for example. But the bigger story is that these stool tests do show more of the “commensal” bacteria than expected, at least in FPIES kids I have worked with. Species like Citrobacter, Klebsiella, Hemolytic E. coli, non-difficile Clostridia, or Alpha hemolytic Strep show up, in spades. It appears that there may be more of these commensal strains populating the gut, than the healthy strains.
Is this the problem? Research needs to be done here for sure. When I work with parents to correct these findings, these kids start to improve. I help parents use probiotics, caprylic acid (from coconut oil) and gentle antimicrobial herb tinctures to balance the baby’s gut biome out. Healthy gut bacteria help digest food, and mitigate inflammation. Your doctor may think a prescription medicine could be useful here too, to aggressively clear the commensal bacteria.
Of course, the other major tool at your disposal is food. Gut bacteria eat what we eat, and they eat first. This is where FODMAPs come in. FODMAPs stands for “fermentable oligo-, di- and monosaccarides and polyols”. A mouthful! FODMAPs are carbohydrates that we don’t completely digest. They are fermented (digested) by bacteria in our intestines. Bacteria aren’t supposed to dominate the stomach and upper small intestine (they help finish the job further along in the GI tract, after our own enzymes and digestive juices have worked on our food), but infections may situate there in the small intestine, up high so to speak, when our own digestion is weak, if immunosuppressive effects are in play, or if a recent infection or vaccination was not tolerated well.
Infections that situate in the small intestine are called are called SIBO (small intestine bacterial overgrowth). These are tricky to culture with a stool test because by the time a meal is digested and passed all the way down to the colon, the microbes that may have been busy with that meal at the start of your GI tract may not be detectable anymore – but they can wreak havoc anyway, especially when we eat foods high in those FODMAPs. Breath tests can detect these, but getting that sample from an infant can be tricky. Invasive procedures to dip-stick a baby’s stomach juices have been done, but it’s far easier to just trial some nutrition and food strategies.
Low FODMAPs foods seem to be helping babies and toddlers in my practice with FPIES. They are turning the corner with some weight gain, improving stools, and no more terrifying FPIES reactions. I shorten this list even further, by removing any foods that don’t meet criteria for Elaine Gottshall’s Specific Carbohydrate Diet (SCD). Many foods allowed on SCD are high in FODMAPs. But by limiting foods to those that meet both low FODMAPs and SCD-legal criteria, I have a short list of foods that are most likely to be easily digestible and least likely to be interesting to the commensal microbial overgrowth in a baby’s gut.
Elaine Gottschall, SCD founder
Some components of GAPS diet can work as well, but I have not seen GAPS alone to work as well as creating individual care plans that draw from low FODMAPs, SCD-legal, and direct interventions to help the baby’s gut biome with probiotics or herbs. It’s trial and error, but the parents working with me on this are the true champions who make it all possible.
Interestingly, grains like rice and oat – two of the most common triggers for FPIES reactions – are first to go when following low FODMAPs and SCD-legal food lists. Soy and dairy products are not allowed either, with an exception in some circumstances for yogurt made from raw goat milk with certain bacterial cultures.
I see rays of hope for FPIES kids, with room to leverage what we already know about irritable bowel disease, inflammatory bowel disease, the role of gut bacteria for good health, and how to use anti-inflammatory foods or anti-microbial herbs or food components. When parents are ready to roll up their sleeves and work with me, it’s a delight when things turn around. For more on FODMAPs, check out Chris Kresser’s post too. And thanks for reading this far!