So you flunked out of GAPS. Now what?
GAPS (Gut And Psychology Syndrome) is a diet strategy branded and popularized by a Natasha Campbell McBride, beginning in 2004 with the release of her first book. The strategy is what functional and integrative nutritionists, naturopaths, and MDs love: Repair the gut with real food. Skip grains and sugars. Eat beautiful fats from organic sources. Use potent probiotics especially from fermented foods. Simple, right?
It is simple, and I love how GAPS is aligned with most everything I do in my practice. But many families have trouble with GAPS, and tell me they just couldn’t keep up with the demands of this strategy. Their kids hate the food. Or it’s too hard to cook so much food from scratch. Or fermenting foods at home is too much trouble. Or it’s too much of a disappointment to have less than stellar results, after this diet purports to cure autism and other illnesses and so many rave about it.
Is there a happy medium? I think so. Here’s 7 Steps To GAPS Success.
1 – Don’t give up on gut health. GAPS didn’t put this idea on the map! It has been around for decades in many other circles, and there are other ways to get there. Gut health for brain health is part of what created the maelstrom of controversy around Andrew Wakefield back in 1998, the British gastroenterologist who wondered (in print) if autism could be linked to viral infection in the gut. It was then that he coined the phrase “gut-brain axis”. This questioning cost him his job and credentials. Now this phrase is a household word for integrative nutritionists like me. If GAPS failed your family, explore other angles for gut-brain health. It really is all about the gut, but GAPS may not be your path.
2 – Consider drugs. I know, I know – no one wants to use antibiotics. Or prescription antifungals. But I have encountered many infants and young children suffering needlessly with failure to thrive, dehydration, chronic malaise, muscle weakness, and seizures because of a refusal (either by parents or doctors) to allow a drug treatment for a found bowel infection. Yes, eventually, a good diet plus probiotics and enzymes in fermented foods may do the trick. But for infants and children, if underweight is a problem, it may take too long – and they may not have this time. If you are on your fourth visit to the ER with a distressed, failure-to-thrive infant or toddler, it’s time. When your four year old’s stool culture shows 4+ Candida parapsilosis, 4+ Staphylococcus aureus, and 3+ Klebsiella pneumoniae, they are refusing any food except fluid milk, and they are not growing or developing as expected… it’s time. Your child may experience immediate relief and improvement with a prescription drug strategy for quick destruction of these offenders. A child’s body can be too weak to fight these things on its own, especially when they are already underweight or at a body mass index below tenth percentile. Usually, drug treatment opens the floodgates for better appetite, better growth, better stools, and better gain and functioning. Your child just may start loving those luscious bone broths and fermented side dishes you toiled over, so you can begin immediately after a drug treatment to build that healthy gut terrain and flora.
3 – Consider strong antimicrobial herbs – for same reasons mentioned in (2) above. There is a cornucopia of beneficial herbal tools that have strong and broad antimicrobial activity. Most herbs also have some degree of immune modulating action too. This can be a double win – you can quickly eradicate a bug that is hanging around too long despite your best cooking efforts, and, you can directly reduce inflammatory immune components at the same time, depending on which herbs are used. You might even go this route before you go to a prescription medicine for bowel infections.
4 – Remember, a “leaky” gut wall often means a more leaky blood brain barrier as well. If your child is suffering from seizures or profound psychiatric symptoms (rage, anger, depression, OCD, anxiety, insomnia, mood swings), consider tools to directly support better functioning at those membranes. Restoring gut health will help the brain! Glutathione, glutamine, aloe juice, dglycerrhizinated licorice, ginger root, and turmeric root are excellent supplements for restoring these tissues and knocking down inflammation. Peel fresh raw turmeric or ginger root and put into a juicer with fresh cilantro, apples, celery, and half a whole lemon for a good soother. You can add a liquid liposomal glutathione (Like ReadiSorb) to this and enjoy.
5 – Review food reactions. Many foods included in GAPS are triggering for kids I meet, especially eggs, dairy, and nuts. I love those foods, but if your child’s body creates antibodies to them, then GAPS is going to be a fail for you. You will need other strategies to calm those reactions besides eating a lot of eggs and nuts! I love helping families sort this out so we can identify other strategies. Sometimes, organic and raw versions of these foods are less problematic.
6 – Slow down on fats. GAPS is big on lots of healthy animal fats, and usually, I am too. I rarely suggest cutting back, since kids need fats for health brains and many other tissues and functions too. And we have become a fat phobic culture to the point where many kids’ diets are low in beneficial fats and high in refined sugars. But if your child has any pancreatic dysfunction, this just may not work. We can find out by using a stool test that assesses fat digestion, something I do often in my practice.
7 – Don’t live GAPS forever. Once your child is doing well, ease up – not to go back onto lots of refined foods. But you may be able to let your child enjoy some wholesome home-made sweets (check NourishingMeals.com for recipes) and some grains (even without sprouting them first), potatoes, or a few other items that are generally verboten (forbidden) on GAPS. The idea is to feel well, grow well, and thrive. Don’t let the dogma become more than your child’s well being.
Still scratching your head? Especially if your child has autism and you have not made the progress you hoped for, some investigation may solve your child’s puzzle to how to use food and nutrition to its potential. Click here to buy my e book 5 Essential Lab Tests For Kids With Autism to learn what tests your doctor can do for you, to sort it out.
Note: Questions for individualized care advice cannot be answered in this forum. For individualized help with your baby’s reflux, bowel habits, feeding or growth, make an appointment so I can give the support you and your baby deserve. You can also learn more on how to help your baby in my book Special Needs Kids Go Pharm Free. Get a copy today if you need step by step instructions that you can try at home. Lastly, if you’re new to my blog or practice, get an intro to integrative whole health for kids here – along with a freebie for joining my list! Thanks for stopping by!
Babies, like everybody else, need to move their bowels daily. Stool that sits in the intestine and colon for too long permits toxins to flow back into circulation, can feel painful or uncomfortable, and can diminish your baby’s appetite. Stool that passes too fast will carry too much fluid out with it, and nutrients and energy won’t be adequately absorbed. More than anyone else, babies are quite sensitive to these dilemmas. Occasional changes in this pattern are of no consequence; persisting patterns are. This is common sense as much as it is sensible nutrition science!
Many things disrupt stooling for babies. Teething, stress, immunizations, antibiotics, badly tolerated foods, and infections or illnesses can all cause changes in stooling pattern, but the changes should be temporary for your baby. Even if your baby has special needs or circumstances, make restoration of comfortable digestion a priority. On balance, your baby should comfortably pass one or two formed soft stools every day (possibly more if exclusively breast-feeding), and it shouldn’t smell terrible. Breast-fed infants have softer, mushier, wetter stools that look more seedy and light brown or gold, and these babies may pass stools more often. Younger babies may also have more frequent stools. But if any of the following signs persist for more than two or three weeks with no explanation, consider it a flag for distressed digestion and absorption. Think about making a plan to correct it, so your baby can absorb all the nutrition he needs to grow and thrive:
- More than four stools per day
- Liquid, runny, or watery stools
- Mucus in stools
- Undigested food in stools
- Stools that are explosive or overflow onto your baby’s back or neck
- Yellow, gold, tan, pale gray, black, or green stools (dark mustard colored stools are normal for breast fed infants)
- Blood in stools
- No stools passed for more than three days on a regular basis
- Hard, dry, pebble-like stool that appears painful or difficult to pass
- Plugs of hard stool followed by explosive loose stool
- Unusually foul-smelling stools
Probiotics are one of the corrections you may want to use to restore a healthy stool pattern. Generally, these guidelines can help. Check with your doctor. If he or she isn’t sure about how to dose and use these, you can always schedule time with me to get targeted help.
- Place 1/8 teaspoon of bifidobacterium blend probiotic powder in your baby’s feeding once a day. If this is tolerated and no improvements ensue, increase to ¼ teaspoon.
- Stop if you notice explosive diarrhea, hives, fever, or sudden rashes.
- Look for Bifido strains such as B. breve, B. infantis, B. longum, and B, bifidum in the product, and a potency of at least 8 billion CFUs per dose.
- Safe Lactobacillus strains that can be added for babies nearing their first birthday or for toddlers are L. rhamnosus, L. casei, L. paracasei, L. gasseri, L. reuteri, and L. salvarius.
- Don’t use L. acidophilus in babies, premies, or infants with NEC. The form of lactic acid made by this species appears to be tolerated poorly in babies. In fact, one study showed that it actually increased allergy (noted as skin rashes) in babies.
- Probiotic powder can be blended with soft food, breast milk, or formula. You can also dust some on the nipple of the bottle or the breast.
- Infants should avoid probiotic strains and blends that are intended for adults.
- Don’t give probiotics at the same time as an antibiotic. The antibiotic will kill the probiotic. Wait until the course of antibiotic is completed, then begin using a probiotic daily.
- If your baby must use antibiotics for longer than two weeks or indefinitely, you can add probiotics at the opposite end of the day. For example, if an antibiotic is given in the morning, give the probiotics in the afternoon or evening.
What does this have to do with reflux? Probiotics can help digestion a lot when used correctly. Digestion, when normal, permits the baby’s stomach contents to move along. When this isn’t happening, food sits for too long in the baby’s stomach. This feels like heartburn, and your baby will cry and be miserable. This can be avoided without medication in many cases. Changing formula, changing diet when breastfeeding to avoid trigger foods, or using various herbs have all proven effective, without the side effects from using reflux medicine for too long. Note: Reflux is not the same as spit up, which happens to babies who are doing just fine. Your baby does not have to lose feedings on your shoulder to be experiencing reflux! Signs can include misery, crying, hiccups, burps, arching with crying, pulling away from feedings, and weak growth pattern.
Goat milk can be used to make an infant formula that many colicky babies tolerate nicely
Reflux, diarrhea, constipation, and colic are not necessarily benign for a baby. They can signal malabsorption, imbalanced bowel microflora, inflammation, infection, milk protein intolerance or allergy, or any combination of these, especially when they persist for weeks on end. These problems can worsen reflux if a baby already has it, or trigger it to begin with. Giving reflux medication can give a quick reprieve from symptoms, but using it longer than a few weeks may set a downward spiral in motion. Work on the causes of the reflux if you can, rather than medicating it away. Reflux medications alter pH of the GI tract, and make digesting and absorbing food harder. They also shift your baby’s gut micro-biome away from ideal species of bacteria that help the immune system “learn”, protect from viruses, and digest food. Instead, reflux medicines favor fungal microbes and detrimental bacteria such as klebsiella or clostridia. These microbes produce toxins of their own that further alter the gut’s pH. They can injure the gut wall, and circulate to your baby’s brain to alter behavior or even trigger seizures.
Some babies whom I’ve encountered in my practice came to me “stuck” on reflux medication, and this is a scenario to avoid. In these cases, the baby will need increasingly higher doses that become less and less effective. One child I worked with was given reflux medication daily for the first three years of his life. Though he had been off this medication for three years by the time I met him at age six, he was stunted with delayed bone age and poor bone mineralization, growth failure, developmental and learning problems, and was unable to eat enough to sustain normal growth since eating was so uncomfortable. He’d had chronic infections as an infant and toddler, needed antibiotics often, and became asthmatic as well. Another youngster who came in for nutrition care at age three was also stuck on it, had fallen into growth failure, and showed the same pattern of not being able to achieve a typical food intake to support growth and gain. Many other toddlers I have met show this pattern of growth failure owing to picky, weak appetites after using reflux medications for a long time (more than a month or two). Reflux medications are intended for short-term symptomatic treatment, not as a long-term strategy. You may have more success by trying the corrections described here first instead, so discuss them with your provider. Your baby will be healthier, and will grow and feel better , when digestion can evolve normally rather than with the digestive down-regulation from the medication strategy.
When unhappy poop patterns persist for weeks and months, nutrients and energy are not being optimally absorbed by your baby. Medicaitons for reflux or constipation may ease the symptoms, but won’t do much to improve the malabsorption. Toxins from this addled gut can be absorbed more easily too. Babies with weak growth amid these symptoms are sending a clear signal that it’s time to intervene. Don’t wait for your baby to slide into a failure to thrive (FTT) diagnosis, which means less than the 5th percentile in weight for age. Babies in growth failure need two to three times more calories per pound per day to recover a normal growth pattern, and this is even more challenging to accomplish when a baby has reflux or other GI issues. Intervene as soon as you notice a “dropping off channel”—that is, if your baby’s weight for age or length for age percentile drops more than fifteen points, it’s time to intervene.
This blog is an updated excerpt from the first chapter in my book, Special Needs Kids Go Pharm-Free. Get more strategies on kicking reflux naturally there – including which herbs are gentle and effective, how to avoid allergy or intolerance to milk, breast milk, or other feedings and formulas, what commercial formulas to avoid and what to try, and tips on breastfeeding a colicky baby. There are many options before going to Zantac that your doctor may not know about!
ABC News featured a story on a boy named Tyler with FPIES – that is, food protein induced enterocolitis syndrome. The boy had been sickly and weak for years; doctors were mystified. Eventually that one needle-in-the-haystack specialist was found who finally had an answer: A diagnosis of FPIES. The boy had struggled against years of unchecked, untreated, undiagnosed inflammation from foods that were not triggering classic allergy reactions, but were triggering chronic, painful, and debilitating immune reactions of another sort. The problem? Nobody ever bothered to look for these other reactions.
The story hit all the usual notes that make for TV you want to watch: Trauma, drama, suffering, heroic efforts, then finally, resolution. But truth be told, FPIES shouldn’t progress to a point where it impedes a child for so long or so deeply. Some lab tests and clinical signs can lead you early on in the right direction. How early? Think neonate – that is, a newborn, age 0-30 days old. You can detect if there’s trouble this early, even without the blood draws, scans, painful prodding and poking, or multiple odysseys to specialists to find out. The ABC news story spoke more to medical tunnel vision, than it did about a true medical mystery!
Many physicians, even gastroenterologists and allergists, overlook immune reactions to foods that are active in FPIES. Though this is changing, it can’t change fast enough: Many still believe that classic allergy reactions – hives, stinging and tingling, or swelling throat – are the only relevant immune reactions to foods, or that anything different can justify diet changes for a child. But as the ABC news piece showed, this is definitely not true.
Recently created FPIES diagnosis codes (see pp 23-25 here) can change that. Before these were added to diagnostic manuals that doctors and health insurers use to code and cover care, IgE reactions were widely considered to be the only valid reactions to foods. Some codes vaguely covered food intolerance symptoms, and a lactose intolerance code has been available for years (a different problem altogether). This left a lot of kids like Tyler undiagnosed and untreated. The new codes help doctors recognize that immune systems have more than one way of reacting to food, if they are reacting at all (which they shouldn’t). If your child has FPIES symptoms, there are paths to improvement that you can begin right away, and your health care provider can now code the care accordingly, so it can be recognized by your health insurer.
I began working with this in my pediatric nutrition practice before it was called FPIES. My own son, born in 1996, presented immediately with inexplicable symptoms – classic FPIES, but nobody knew that at the time: Projectile vomiting after feeding that left him limp, flaccid, and pale – and even unconscious for a few seconds on one occasion (talk about being a terrified new mom!). He had explosive, runny, liquid, mucousy stool, 8-12 times/day, even though he was breast fed; allergic shiners at his eyes; relentless crying and colic; eczema flares up and down his body; thick cradle cap. Though I’d completed my graduate and undergraduate degree trainings and my registration status as a dietitian years before, I had never heard of anything like it, even during my stint at WIC clinics where I saw plenty of babies. Friends and family with babies of their own hadn’t either. By the time he was 8 months old, we’d rotated through breastfeeding, breastfeeding on a carefully restricted diet, hypoallergenic formulas, and then finally settled on a homemade goat milk formula that I felt confident creating myself, as a trained dietitian. It worked like a charm for him, and has for many babies in my practice since. But, it doesn’t always turn out so easy. The good news is, there are more tricks to try.
Our pediatricians were non-plussed, and didn’t ponder food intolerance or allergy at all, even as my son started to slide down the growth chart before he was two months old. They offered semi-elemental formula, which gave only mild improvement and created other problems – like stark (as in, no stool x 12 days) constipation. When I asked for an allergy referral in his first year, I was told “babies can’t have allergies.” They didn’t wonder why breast milk would not be tolerated by a baby. One physician even told me I “over-nursed” him – which was especially silly, since my son had dropped from 45th to 10th percentile for weight between his birth and age six months.When the allergist found him to have several IgE reactions, he wearily told me my son would surely grow up with asthma and severe food allergies. I refused to believe it (and it didn’t come true)!
It was plain that this baby of mine had inflammation in spades, and that his gut was part of the puzzle – but why? This question is how my pediatric nutrition practice got started by 1999. How could a baby who is born at a healthy weight, with perfect Apgar scores, after a healthy term pregnancy, and a natural, drug free, vaginal delivery – become so inflamed? It was as if he was on fire all the time, just screaming, in seeming agony from the inside out. How could this be thought of as normal, or so inscrutable to smart physicians everywhere?
Of course, it isn’t, and there is a lot you can do. Your baby needs and deserves to be comfortable, and so do you! No need to wait for years for answers, or search for specialists far and wide. If you see FPIES symptoms in your baby, no matter how young, you can step in.
1) Change the protein source. We all know that breast milk is a perfectly-matched-for-us blend of human casein, whey, lactoferrin, and other protein molecules that modulates the immune system, nourishes the intestinal wall in unique ways, encourages growth of an optimal gut biome, and aids uptake of nutrients. If FPIES symptoms are active this early and your baby is breastfed, consider removing usual trigger proteins from your own diet, like cow’s milk/dairy, soy, nuts, gluten, eggs, or corn. Experiment with rotating foods, find what is problematic. Be sure to replace any foods withdrawn with nutrient dense alternatives. As a nursing mom, your nutrition needs are high. Eat plenty of protein, minerals, and healthy fats/oils. Eat organic; GMO foods have been linked to increased allergy, and this is the last thing an FPIES baby needs.
2) If your baby is formula fed, or if breastfeeding is a complete bust, know that your baby may feel better with a semi-elemental formula like Alimentum or Nutramigen. If that is a no go, FPIES symptoms may respond better to elemental formulas instead, like Neocate Infant or Elecare (if they don’t, there’s a troubleshoot path for that too). These are not organic options, but some manufacturers are trending toward non-GMO ingredient, such as Neocate.
3) Consider goat milk infant formula or make your own. This was the charm in my son’s case, and can be worth a try. If making your own, use molasses, not corn syrup, for carbohydrates; your baby may or may not be able to tolerate brown rice syrup in this role. Add multivitamin drops for infants once daily; add healthy brain fats like coconut oil or flax oil. Ultimately, you may need to use elemental free amino acids as protein source and build your own “modular” formula. This requires oversight and guidance from a licensed dietitian or knowledgeable MD. I have used this method in my practice for infants with success – it can work.
4) Rule out bowel infections. Research into the human gut biome is rapidly growing, and it’s clear that newborns with an addled gut biome have more trouble for allergies, FPIES, feeding, growing, immune function, and even learning and brain development. Good gut bugs keep pathogens out, trap toxins, communicate with the immune systems, protect the gut lining, and aid digestion. In babies, the intestine is immature and permeable, and the job of the gut biome is to help it mature. This is pivotal for aiding digestion and absorption of nutrients, is critical in setting up normal immune function, and mitigating allergies and asthma later on. Most any gastroenterologist will check for the more nasty bacteria species with a stool culture. But this often skips FPIES culprits like fungal (yeast) species, which can be especially disruptive to a newborn gut when present to a dominant degree. A functional medicine comprehensive digestive stool analysis will look at all sorts of microbes, from parasites (think microscopic ones like amoebas or protozoans that are impossible to culture) to the full line up of pathogenic bacteria. This test also profiles beneficial flora, so you can see if important helper bacteria are colonizing your baby’s gut or not. I use this test often to redirect the biome for babies. The test also measures stool for markers of inflammation and good digestion, without drawing blood, and this directs my choices for safe foods or supplements also.
5) Check gluten. A negative celiac test does not mean your child can safely eat gluten. It just means there is no celiac disease. At the very least, have your team do an IgG antibody test specifically for gluten and gliadin. These are usually left out of celiac test panels, so it is common for children to be told to continue eating gluten when they should not. Eating gluten when the immune system is reacting to it can deeply disrupt the gut’s ability to absorb other nutrients, and can trigger autoimmune reactions to brain and other tissues. There are detailed gluten sensitivity panels available that can check several immune responses beyond IgG and IgE, to thoroughly categorize how your child’s body responds to wheat.
6) For children past 18-24 months of age, run a full ELISA IgG food antibody panel. These tests have been available for years from specialty labs like Alletess, Genova Diagnostics, MetaMatrix, or Great Plains Labs. One tube of blood, or even blood spot finger prick samples, is used to assess over 90 foods for this type of reaction – a small sample goes a long way, and you don’t need to pull several tubes of blood out of your child. Some GI doctors are now using ELISA IgG tests also, but usually only do a few foods with more blood pulled. If multiple positives result on the panel, don’t panic – start with the most frequently eaten foods and engage alternate protein sources. I do this in my practice routinely, and add supports to help build a healthy intestinal wall as well.
Depending on findings from these labs, I help families create a plan that engages foods, formulas, supplements, probiotics and rotation diets safely. There are many options to safely redirect a child’s intestinal environment, so that it can function as intended and develop peacefully, allergy-free, or with fewer allergies. I like to work in tools to soothe the gut wall directly, like liposomal glutathione, pure organic aloe juice, slippery elm, and the right probiotic, in addition to a replenishing, non-inflammatory diet. This takes time – months or even a year or two, depending on the degree of gut injury at the outset – but I have seen it turn FPIES around, and lengthen the list of safe foods.
What about the mystery part – what causes FPIES? In my practice, the children who suffer most have been exposed to a variety of factors that disrupted or diverted the development of a normal, healthy gut biome in utero, at birth, or within the first few months of life. Antibiotics and vaccines are potent tools that can disrupt biome colonization and immune signaling early in life, at birth, or possibly even in utero. The full reach of effects from these practices is largely unstudied. C-section births also disrupt gut biome colonization for newborns, because they never get that “vaginal gulp” of flora from mom on the way out – which should ideally be in top form during pregnancy. Giving your baby a start in life that is as close to what nature intended as possible is one way to lay a good foundation for avoiding FPIES, allergy, and asthma later on. Nobody’s perfect, and babies can develop FPIES nevertheless, just like mine did. But with early and targeted helps, children can go on to enjoy most any food, or at least eat a minimally restricted diet. Just like mine did, and others in my practice have too.
Sunday is food shopping day (er, night) in my house. My husband took this on years ago – it’s his job. He is better at it than me – faster, more organized, more clinical (he’s an engineer). I get distracted. I’m too interested in new stuff on the store shelves, I meander, I like to read labels on items I don’t even buy just because it’s interesting – even the junk, because I’m amazed by what passes for food, what fills the aisles, what people are buying. I take too long and spend too much. He fired me.
He also sits us both down before the shop, to pin down exactly what our meals will be for the coming week. That can be the hardest part – we blank out. So we keep a list of dinners made over the years and add to it often, when we find a new idea we all like. This has really helped my family eat well. We are spendy on good organic food, and don’t eat out often – something not all families can swing – but just the act of choosing what’s for dinner a week in advance is a worthy time, money, and health saver. Here’s some ideas to get you started – in my house, these meals have to be free of gluten, soy, corn, dairy, and most nuts.
Salmon with saffron sauce and chick peas
…Salmon with saffron sauce and chick peas (Recipe from Hummus and 65 Other Delicious Recipes) with brown rice
…Minestrone Soup from scratch (Recipe from Special Needs Kids Eat Right) with GF Chebe rolls (store bought mix)
…Meatloaf (Recipe from Special Needs Kids Eat Right) with quinoa cooked in chicken broth, green salad, green beans. Sounds pedestrian but try this recipe. It’s good.
…Vegetable Frittata over GF Penne (use any veggies but we like asparagus, onion, spinach, mushroom, and pepper)
…Lentil Shepherds Pie with green salad (here’s the basic idea of this recipe; we use So Delicious or Silk coconut milk instead of cow’s milk, ghee, and green beans instead of corn)
…Pork or Chicken Adobo with brown rice and baked sweet potato
…Spaghetti and meatballs (from Special Diets for Special Kids), green salad, summer squash with oregano, Chebe rolls
…Curried chick pea skillet dinner (from Special Needs Kids Eat Right) over spiral GF pasta
…Coconut chicken curry with sweet potato over rice
…Thai red curry sauce over mahi or haddock (if available) from Blanchard’s A Trip To The Beach with GF risotto and ginger carrots (slice fresh carrots into skillet with olive oil and fresh ginger slices. Add a dusting of curry powder, dash honey, and enough chicken broth to keep from sticking. Cook to desired softness over medium heat).
Adding lemon slices while cooking chicken picatta makes it even better
…Portuguese kale soup (recipes abound, our own version is in Special Needs Kids Eat Right), Chebe rolls.
…Kale calzones with brown rice green pea salad
…Roast chicken, potato, onion, carrot – baked in one big Pyrex. We buy a half chicken with skin; the organs that come with it go to the cats.
…GF penne pasta with pesto – we make ours with pine nuts, which are safe in our house (not walnuts), and skip the parmesan in the recipe.
…Stuffed bell peppers (blanch the peppers, then stuff with whatever mixture you like: raisins, bread crumbs, leftover minced pork or ham, pine nuts, cashews, onions, mushrooms, brown rice, your favorite seasonings – then bake), chicken sausage
…More: Lemon chicken picatta, home made chili, pork loin, stuffed pork chops or chicken (we use mushrooms, minced ham, onion, bread crumbs – whatever is on hand); pot roast or beef stew, lentil soup and hot dogs
…A side of fresh vegetable, stir fried greens, and/or fresh garden salad with homemade dressing is almost always on the table, when vegetables are not featured as a main course.
No doubt I am blanking out again as I type, which is why I keep cookbooks on hand that I like to thumb through again and again – like The Victory Garden Cookbook (1982), Yankee Magazine’s Favorite New England Recipes (1972), Whole Life Nutrition Cookbook (2006), Top One Hundred Pasta Sauces (1987), Gluten Free Italian Cookbook (2008), Hummus and 65 Other Delicious Recipes (2006), a now dog eared Joy of Cooking that was given to me in 1979, and many others. Whether you can manage just one or two home cooked meals a month, or several a week, make them special occasions where your family knows they are being cherished with good healthy food.
So your child is underweight, not eating well, not growing well. You’ve been told to give him calorie dense drinks like Ensure, Pediasure, or Boost; lots of butter, pudding, whole milk, and cream; and of course, lots of ice cream. Is this healthy?
Seeing these common recommendations is one of my least favorite findings as a dietitian in private practice working with kids. There are four problems here that can interfere with restoring your child’s robust health:
One, these drinks and foods are made with conventionally raised dairy products, which can contain bovine growth hormone, pesticides, traces of genetically modified feed corn proteins, and antibiotics, not to mention possible heavy metals from agricultural chemicals. All of these agricultural interventions have been linked to problems ranging from higher incidence of ADHD to earlier onset menses, other hormone disruptions in boys and girls, allergies, and neurological disorders.
Two, the child’s underweight status may be at least partly due to an undiagnosed milk protein intolerance or allergy – which irritates and inflames the gut, making nutrients and energy even harder to absorb. Be sure to get this sorted out before relying on any milk protein sources in your child’s diet.
Three, milk protein (casein) is often a constipating protein source, especially in children with some digestive insufficiency issues, like reflux or imbalanced gut microflora. Healthy gut microflora (bacteria) add enzymes to help us digest and absorb food, and keep bowel habits on track. If your child is unable to comfortably pass a soft formed stool most every day, then appetite can weaken – exacerbating the problem of packing in calories.
Last but not least – drinks like Ensure, Boost, and Pediasure rely on refined sugars and corn syrup (in various forms) to up their calories. I don’t like this because corn syrup is noted for containing a bit of mercury in every teaspoon, thanks to agricultural processing. Corn is also a genetically modified crop. Emerging research suggests that proteins in foods from genetically modified crops can trigger allergy. More allergy = more gut inflammation = more difficulty absorbing nutrients and energy = poor growth and gain. And, there is no sound argument for relying on refined sugars as a major strategy for growth and gain in children.
You can do way better.
First, make sure you are not battling undetected food sensitivities or food allergies. Get tested! You may need to avoid milk protein sources entirely, in order for your child to feel hungrier and digest more comfortably. Many labs and providers can assist with this, and this is a specialty in my practice too. Make sure you look deeper than just IgE allergy responses with a conventional MD allergist. For more information on this, see either of my books.
If eggs and nuts are allowable, get a powerful blender or food processor – the sky’s the limit, with those two ingredients adding creaminess without milk or ice cream. Everything on my list below is organic, no added sweeteners in the milk substitutes, and raw where possible. When using nuts, blend those first to smooth consistency with ice and a small amount of the recipe’s liquid. Then add remaining ingredients til smooth.
Banana Cream: ¼ cup raw cashews, 1/2 ripe banana, 1 cup almond milk, dash vanilla flavoring, 1/2 c crushed ice, 2 TBSP sesame tahini, 1/8 teaspoon stevia powder, hefty dash cinnamon. Add cacao nibs or if you don’t have those, organic mini dark chocolate chips (1 teaspoon) for additional zip. Blend ice, cashews, tahini, and 2-3 ounces of almond milk together first, until smooth and creamy. Add vanilla and remaining almond milk, and blend again til smooth. Add cacao nibs and blend to desired consistency.
Raw cashews, tahini, and banana with ice, almond milk, vanilla, and stevia make this smooth and creamy.
GI Soother: 2 peeled apples, 3 stalks celery with leaves, 5 mint leaves, 1/3 seeded peeled cucumber, 2 teaspoons ground flax seed or ½ teaspoon flax seed oil, ½ – ¾ cup white grape juice, 2 TBSP whole coconut milk, crushed ice
Not Latte: 1 cup organic brewed iced (decaf) coffee, 1 raw egg, 1/2 teaspoon maple syrup, 1 TBSP sesame tahini, 3 TBSP cashews, 3 ounces almond milk, 3 ounces whole unsweetened canned coconut milk, crushed ice
Power Peanut: ½ soft ripe avocado, 1 TBSP cacao nibs, 1 TBSP hemp protein (such as Nutiva brand), 1 TBSP peanut butter, 3 ounces whole unsweetened canned coconut milk, 3 ounces almond or hemp milk, 1 teaspoon honey, crushed ice
Pineapple Smoothie: Fresh pineapple chunks ¼ cup, 1 ripe banana, 3 ounces whole coconut milk, 3 ounces unsweetened almond milk, dash vanilla, 2 teaspoons flax seed meal, 1 whole egg + 1 TBSP egg protein powder (option: try soaked hemp nuts in this one too)
These two are modified from a favorite book of mine called Raw Food Cleanse, which has several great recipes for smoothies, soups, and dips.
Soup Option, serve warm: ¼ cup raw cashews, 1 cup vegetable broth (such as Imagine brand organic), 6 stalks fresh young asparagus, 2 stalks celery with leaves, ¼ teaspoon fresh thyme leaves – blend all til smooth.
Pumpkin Navel: ¼ cup raw pecans, 1 navel orange, ¼ teaspoon orange zest, ¼ cup pitted dates (soak these ahead of time to soften), dash vanilla, crushed ice, ½ cup almond milk, 2 TBSP cup cooked canned pumpkin puree, 1/2 teaspoon honey or dash stevia
Honeydew Lime Creamsicle: Click here for this really good smoothie – doubles as frozen pops in hot weather.
– For any smoothie with fruits like kiwi, berries, papaya, peaches, pear, or mango, adding a raw egg or ground flax seed will create a creamy texture while adding healthy fats, protein, and minerals. Using egg protein powder is an option too. This will make your smoothies fluffy and creamy at the same time, but won’t add the fats you might like.
– Raw nuts blend to a nice creamy consistency with the right tool – a powerful blender, Vitamix, or Bullet mixer. Soak raw nuts (and seeds) ahead of time if you like a more smooth, less grainy texture.
– Hemp seeds, flax seeds, chia seeds, and cacao nibs are up and coming as alternative sources of protein, healthy fats and oils, and minerals. Add these to any smoothie to boost nutritional value along with calories.
– Wean sugar-holics off their favorite processed calorie booster drinks by making your own without any added sugars: Instead of honey, maple syrup, or molasses, switch to an organic stevia powder, which is potently sweet at a tiny dose. One eighth teaspoon is enough to sweeten an 8 ounce blended drink. Add cinnamon in larger amounts – 1/4 to 1/2 teaspoon – to kick up the sweet and benefit from cinnamon’s blood sugar modulating effects.
– Unconventional but healthy options for sweeteners in smoothies can create the creamy texture kids like, plus add extra fiber, vitamins, and minerals to smoothies. Try left over baked sweet potato (skins removed), cooked canned pumpkin, or leftover roasted mashed parsnips, which have a surprisingly pleasant and gentle sweetness when prepared this way (easy, fast, and good; use ghee, not butter, for extra sweetness and to avoid dairy protein).
– Cook brown rice in whole coconut milk with honey, nutmeg, and cinnamon for an alternative to all the pudding your child may have been told to eat. Use a slow, low heat method and add almond or coconut milk to the liquid if needed during cooking. An hour or more of slow cooking may be needed.
– Use coconut milk to make mild (but calorie laden) curry sauces that can go over favorite chicken or fish dishes.
– A good blender or VitaMix will turn raw nut pieces into a creamy smoothie, but organic nut butters are an option if using whole raw nuts is too gritty a texture for your child.
– Get the benefit of butter without the allergy or GMO hassle by using organic ghee (clarified butter). Pricey, but when you need it, you need it. Ghee has a sweeter taste than butter that isn’t clarified.
– Skip the soy. Even if it isn’t genetically modified, it’s a frequent allergy offender, just like dairy protein. And there are endocrine effects from soy that are concerning enough for me to suggest that parents don’t use it as a major daily protein for a child. Translation: A serving here or there is fine, but don’t use it as your child’s protein source at every snack and meal daily. Soy protein is a common addition to bottled smoothies, energy bars, and protein powders.
– If multiple allergies are in the picture – and nuts, eggs, and seeds are out – then work with a knowledgeable nutritionist who can assist with using essential amino acids, medium chain triglycerides, and safe oils to build smoothies around tolerated carbohydrate sources like ripe peaches, pears, avocado, plums, or winter squashes and pumpkin.
These options will give your child several nutrients, healthy fats, more protein, and calories to burn that are head and shoulders above some corn syrup, vitamins, and milk from a cow raised on chemicals. Remember that poor appetite and weak growth pattern can be signs of deeper problems with the GI tract, digestion, absorption, or inflammation. For strategies to sort these out, see either of my books, or get in touch. Troubleshooting growth pattern is one of my specialties in practice.
Gluten-free is a big part of my pediatric nutrition practice. It has also been my life since 1998, when we pulled gluten out of my son’s diet. He was 22 months old. Within two days, he had the first formed stool of his life. No more gold slimy lumpy stuff to burn his skin. Bloating, gone. Allergic shiners, gone. Anxiety, crying, sleep – all began to improve dramatically.
This was a big eye opener for me, after a very difficult start for my son. I’d been a nutrition professional for a decade, and had two degrees in nutrition; I was a registered dietitian who had worked in research, grant writing, and patient care. But I never knew gluten could wreak so much havoc without a celiac diagnosis. None of our pediatricians suggested this path; in fact, they opposed it. But this was a huge help to my son, who is still gluten free at age 20 today.
What our doctors didn’t realize is that you can have gluten sensitivity – an immune response to gluten – without celiac disease. Celiac disease is an end-stage symptom of gluten sensitivity. It can leave an intestinal wall atrophied and unable to function; it may trigger chronic diarrhea, unintended weight loss, meager growth, anemia, or skin changes (dermatitis herpetiformis).
Gluten sensitivity can precede a full blown celiac diagnosis by many years. It can wreak havoc on the brain and epithelial tissues (GI tract, mouth, tongue, lungs), and can increase your risk for certain cancers and neurological conditions. Gluten sensitivity is also implicated in many autoimmune conditions besides celiac disease, from diabetes and Hashimoto’s thyroiditis to muscular dystrophy.
Celiac disease, which is an autoimmune reaction to your own gut, is just one of many symptoms of gluten sensitivity, albeit an end-stage one. What is rapidly emerging in medical practice and academic press is that eating gluten can trigger autoimmune reactions in tissues besides the gut, such as your thyroid gland or your brain.
This isn’t a fad, or fiction. It’s fact. But the grey area is individual variation.
Whether or not someone will benefit from a gluten free diet takes thoughtful assessment with a knowledgeable practitioner. Ultimately, only actually trying a gluten free diet will answer this question for you – but, see below – it has to be uber strict, and long enough for the body to drop circulating levels of antibodies to gluten. Only then will those antibodies no longer be able to attack any of your own tissue in an autoimmune, cross-reactive fashion – and this can take four to six months at least. “I tried it for a month and it didn’t work” doesn’t mean much, unless you do actually have celiac disease. In that case, most people feel better pretty quickly, as soon as a three or four days going gluten free.
So, does your child or teen need a gluten free diet? Or is it just a fad? You can ask your pediatrician, but he may not be much more informed than mine were. Many docs still regard gluten sensitivity as benign, and don’t even check for it; others only advise avoiding gluten once it creates the full meltdown of celiac disease, confirmed with biopsy.
Luckily, you can find out exactly what is up for your child. Several resources are available now to look for gluten sensitivity. If your pediatrician isn’t helpful with tests below, you can work with DirectLabs.com to sort it out, or contact me for an appointment. I provide screening for gluten sensitivity, celiac serology, or gluten allergy if other resources in your insurance network can’t or don’t. And, I guide families on how to transition off gluten, what to eat, how to cook and bake gluten free, and more.
Gluten Reactions: Lab Test Basics
Wheat Allergy Test: This test checks for immunoglobulin E (IgE) reaction to wheat. A pediatrician, family practice doc, allergist, or GI MD is the usual in-network resources to order this blood test for your child. This can also be checked with a skin prick test, to see if a hive or wheal develops. It checks for a classic allergy reaction, which will usually create symptoms like hives, vomiting, headaches, stomach pain, constipation/diarrhea, eczema. Wheat allergy can be negative while gluten sensitivity is positive; the two don’t always happen together, so both should be ruled out.
Gluten Sensitivity Test: This test checks for a sensitivity or delayed reaction to wheat or gluten, mediated by immunoglobulin G. It can also check IgG to gliadin, which is part of gluten. If you need to reach beyond your pediatrician, allergist, or GI doc for this blood test, check with labs like Cyrex, Alletess, Great Plains Lab, or Genova Diagnostics. Common symptoms with sensitivity to a food protein include irritable stools, reflux, bloating, headache, mood changes or anxiety, fatigue, allergic shiners at eyes, mild eczema that comes and goes, difficulty with schoolwork or attention, and sensory irritability.
Gluten Sensitivity Test, Again: EnteroLab and Genova Diagnostics use a stool or saliva sample to check for other gluten-reactive immunoglobulins called IgA and IgM. No blood draw needed, but false negatives may be more common with this test, especially for people with chronic illness or weak overall nutrition status.
Genetic Testing: This checks your genetic odds for being gluten sensitive or acquiring celiac disease, but doesn’t measure reactions to gluten. This is often done as part of a celiac diagnostic process, because it’s unlikely you will develop celiac disease without the gene haplotype that helps make it happen. Click here to learn about HLA-DQA1 gene and here for HLA-DQB1 gene.
Tissue transglutaminase (TTG), Reticulin, and Endomysial Antibody Tests: These tests look for antibodies to your own gut tissue and enzymes. If positive, celiac disease is highly suspect. A gut biopsy may follow, to see if your gut wall is actually already damaged by the chronic autoimmune inflammation caused by these antibody reactions. In this case you are literally attacking yourself. These do not gauge reactions to gluten itself. The gluten sensitivity tests mentioned above can be positive, while these autoimmune reactions are negative, a scenario I’ve seen hundreds of times in my pediatric nutrition practice. Ding! You don’t have celiac disease (yet). You do have gluten sensitivity, and may benefit from a gluten free diet.
Elimination Diet: This means total avoidance of gluten for a while, to gauge improvement. Persons with celiac disease usually improve quickly when they first withdraw gluten, within a week or two or even faster. Persons with gluten intolerance may not notice dramatic shifts until a few weeks later. And, if there are other food proteins that bother your immune system, you may not notice any improvement on a gluten free diet at all. This could mean you’re not reactive to gluten, or, it could mean you react to gluten and some other foods you didn’t withdraw. Not sure? Do some blood work to sort it out. Especially for kids, elimination diets are cumbersome and time consuming. If your child is struggling, it’s expedient to do the lab testing. Talk to someone knowledgeable about gluten sensitivity who can review lab findings in the context of signs and symptoms, for a final decision on what to do.
Fad? Nope. We are in the midst of a scientific discovery process that many people may not tolerate gluten. And we haven’t even touched on the controversy around how the wheat we grow and eat today has changed dramatically in the last sixty years, possibly contributing to the problem, as has the heavy use of pesticides on it like glyphosate. Many conditions may have an inflammatory component that includes gluten sensitivity. Such as…
ADD or ADHD, autism, non-verbal learning disability, Asperger’s syndrome
Type 1 diabetes
Anxiety, depression, mood swings
Reflux, picky weak appetite, slow growth or gain
Sensory challenges, verbal or motor dyspraxia
Anemia, iron depletion, frequent infections
Chronic irritable stools, constipation, loose stools
Chronic headaches or migraines
In those scenarios, I regard gluten guilty until proven innocent. The fiction part? It’s definitely fiction that symptoms hobbling your child’s learning, growth, or behavior don’t matter. They do matter, and you can easily find out if gluten is part of the story. If it’s working against your child, a gluten free diet will be worth it. It’s so much easier than it was in 1998!