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Don’t Let Food Allergies or Dietary Restrictions Ruin Halloween

Don’t Let Food Allergies or Dietary Restrictions Ruin Halloween

Halloween used to be pure fun, but now that so many kids have food allergies, it’s definitely complicated. Somewhere between 8-10% of US children have a life threatening food allergy. Among those, about 40% are allergic to more than one food. I’ll bet food allergies may be underreported – just in my own pediatric nutrition practice, I often meet kids who have never been screened by their pediatricians or referred to allergists – and lo and behold, we find food allergies.

Then there are also food sensitivities, and food intolerances. These can occur with or without allergy reactions (which is why your child may still feel or function poorly eating a certain food even if your allergist said it tested ok). Sensitivities involve layers of the immune system different from allergy reactions and tend to emerge more insidiously or slowly, with eczema, anxiety, stomachaches, picky weak appetite, or irritable stool pattern. Intolerances can be immune-mediated or purely digestive in nature, and can include those wacky behavior changes some of you see when your kids eat stuff heavy on dyes and sugar…. like, Skittles! Kids can have one or all of these problems at once – allergy, sensitivity, and intolerance – to some of the same foods, or entirely different foods.

There are ways around it. It’s not like it used to be when kids could go door to door (without parents even!) grabbing goodies indiscriminately, and bickering over who got what with siblings once home (always interesting at my house growing up with five kids). Here are tips to help your kids have fun on Halloween even if they have food allergy and dietary restrictions.

  • Teal Pumpkin Project – if you haven’t heard about it yet, dive in! Look for the Teal Pumpkin for non-food treats and little toys.
  • Trick or Treat Fairy who takes your child’s candy cache and leaves a coveted toy (or toys) in its place – like the Tooth Fairy, only better.
  • Bake some allergen friendly treats to trade for candy. Cookies, bars, cupcakes, or even Halloween themed fat bombs – the choices are endless.
  • Organic-ingredient candies are often allergen-friendly. They are pricier, but worth it if it means avoiding that ER co-pay or Epi-Pen drama, or just for your kids’ joy and peace of mind. Here are some examples (I have no affiliate relationships with these brands BTW – I just like these a lot)
    • Alter Eco makes non GMO organic chocolates in several varieties. They aren’t certified gluten free, but have no gluten ingredients, and many have no nut ingredients. Some do have milk ingredients. Check out the Quinoa Crunch or Burnt Caramel, two of my favorites.
    • The Natural Candy Store lets you choose candy by dietary restriction and by organic candy status.Give their grid a try, see what you get – it’s genius! Here’s what I got when I selected strict gluten free, strict peanut free, certified non GMO, no corn syrup, certified organic candy.
    • Yum Earth makes certified GF, organic, nut free, non GMO and vegan (that means strictly dairy and egg free) candy ready for Halloween sharing.

Be Sure You Don’t Make This Halloween Food Allergy Fail! …Here’s a mistake I witness often working with well meaning parents: Feeling sorry for your child. Or, unwittingly, for yourself.

When a parent comes in after we’ve started nutrition care process and spends a lot of time explaining why this can’t work because it is too hard to find or prepare substitute foods ….Hmmm. That’s not where we need our focus, and it is not what your child needs to hear from you. It’s also more about you than your child. You’re in charge of what is in your house to eat, and you do have a large measure of influence over what your child eats at school. Let’s strategize about how to do it, not about how hard it is. And truth is, it’s not so hard – once you decide it isn’t, commit to it, roll up your sleeves, and get started. It’s not too different from a weight loss project: Ultimately, you just get your butt in the gym and change up some eating habits you know aren’t helping, and you make it a lifestyle commitment.

Forget the drama about how they’re missing out. Talk about that in front of your kids, or worse – to your kids – and they will believe they are missing out and will feel bad about it. Talk up all the new choices there are to explore, and engage your kids in the discovery process, whether it’s making homemade treats, taste testing new store bought ones, or dreaming about the toy-trade options. Happy Halloween!

 

How To Get A Decent School Lunch In Your Kid’s Belly

How To Get A Decent School Lunch In Your Kid’s Belly

How do you get your kids a decent lunch at school? You’re over the top with beautiful Bentos, containers, and boxes for all the best snacks and sandwiches you can think of, you’ve tried every healthy power bar, fruit, carrot sticks, rolled up turkey, hummus… You’ve resorted to the junk: Cheddar Bunnies or Goldfish, pretzels, chips, sugary granola bars… and it comes back barely touched at the end of the school day, right? Or you’re buying school lunch, but have no idea what it is, whether your child eats it, or why they come home and melt into tantrums day after day (hunger, maybe?) Here’s five tips to help this go a little better.

1 – Let yourself off the hook – and your kid too. You’re not the problem. Neither is your child. The school is. Lunch is too short, too chaotic, and too impersonal. Incredibly, some children literally don’t get to eat lunch at all, as they spend too much time lining up to get it and finding a table. Here is one example of a school where children actually dumped untouched trays of food in the trash because it was time for recess by the time they’d gotten their lunches – they never got to eat at all. No amount of curriculum is worth this. You can stuff curriculum into kids’ faces all day if you like, but guess what? It won’t work. Because when children are hungry, attention and learning drop. Hmm maybe this is why we hear that US kids are falling behind compared to other countries?

By contrast, check out this story and video about how school lunch is served in France. Imagine how differently children learn to value food, community, self worth, and social interaction, when they get to eat this way. Oh well. We are probably not going to get there anytime soon in the US. But I share this to illustrate how absurd it is to expect children to function well in our version of a school lunch system. It does not engender health, good digestion, or appreciation for food, self, or how to contribute to a positive group experience. Our system is downright competitive, and anxiety provoking, as kids must worry about what they’ll get, when they’ll get it, if they can eat it, how fast, where to sit… and must do it in a cacophony that could make your ears bleed. So give in to the fact that how your child eats at school is something you can’t likely change, at least not this week. Make up for it with family meals at home as often as you can, whether it’s breakfast or evening meals. Having family meals together on a regular basis has been shown to boost kids’ vocabularies, grades, and intakes of nutrient-dense foods.. and it lowers high risk behaviors in teens like drug use and drinking.

2 – Let your child eat what is easy during the school day. Literally, anything is better than nothing. Pack high protein finger foods, starchy snacks (yes, you read that right), and comfy favorites. Don’t worry about the carrots and celery that come home. They’re not going to help much anyway during the busy school day. Your child needs high density food. Their brains use nearly half the total food energy they eat every day, just to be and learn (adult brains use about half that amount). Starchy snacks give fuel quickly and while we can argue all day about why they’re bad, they are better than nothing. Think of it this way: You’re flight was delayed and your stuck in an airport terminal at 4 AM with nothing open for food. You never had dinner the day before or breakfast this morning. But wait: You found some crackers in your purse. Eat them, for God’s sake! Yes, it’s junk, and, it will give you a little help til you get to your destination. It’s not what you’re going to eat every day, but you’re glad to have it in that moment. Likewise, don’t sweat it if your child is eating some low value starchy snacks during the school day sometimes. Avoid processed high sugar or corn syrup snacks – but a blondie brownie (gluten free if necessary), made with strong organic ingredients, coconut sugar or maple syrup instead of cane sugar, and some awesome ghee or coconut oil for a brain boosting fat isn’t at all that bad. If allowed at your kids’ school, throw in some crushed cashews or other safe nut. A dense homemade or store bought bar every day with clean ingredients isn’t all that bad.

Lunch at an Iowa school, 1939 (courtesy Library of Congress)

3 – Fast finger foods are an obvious help. Expand on the starchy goodies by including some protein and fat rich options, like olives, hard boiled eggs, jerky or meat sticks, or collagen bars like BulletProof, Dr Axe, BonkBreaker, Caveman, or Perfect Bars (some from this brand have peanut). Other bars may source the protein punch from dairy, using whey or casein; you’ll need to skip those for a dairy free child. You might also see soy, rice, hemp, or nuts as protein sources. Scrutinize ingredients to fit your child’s needs. Generally, grass fed collagen is a good protein source that is non-allergenic for most kids. Another great option: Fat bombs, bite size power packed snacks that are easy to make at home with a few ingredients, and are beginning to appear on store shelves in various forms. Here is just one site that offers a cache of 45 fat bomb recipes. Look around the web for more from sites like Paleo Hacks, Paleo Plan, or under names like Paleo Energy Balls. Those recipes use nut butters often; some schools have a zero nut policy while others only limit peanut or have a nut free table. Lastly – macadamia nuts, if allowed at your child’s school, have the highest fat and calorie content of any nut. Even a few nuts give high octane fuel that can make the day’s journey easier. Ten nuts yields about 200 calories. Throw in a few organic, stevia sweetened chocolate chips if you want to make it a treat that skips sugar.

4 – Make the liquids count. Instead of juice pouches or boxes, consider a midday meal replacement power shake that adds fat, protein or micronutrients. Options abound for ready to drink stuff you can pack in your child’s lunch. Orgain drinks are widely available (even at Costco) in both vegan and dairy protein source versions. The vegan version is gluten, dairy, and soy free. I also love Rebble Protein Elixirs. A little pricey, but they are dairy, gluten and soy free, with big protein boosts from pea, sunflower, pumpkin seed, or hemp. They are less sugary, more nutritious, and cleaner than stuff like Boost or Pediasure, which are high corn syrup and low nutrition value with only GMO fed cow casein and GMO soy as the protein sources.

Many kids with severe allergies need an even more specialized product. One example is Splash ready to drink elemental formula for children. Though many in the integrative nutrition communities love to hate this stuff, in certain cases, I have seen it be quite successful for children with feeding difficulties and multiple food allergy. Downside: High cost, but may be covered on insurance for kids with documented multiple food allergy.

You can of course also always make your own smoothie and send it to school in a single serving container, but keep in mind that this makes more work for you, and it may take more steps for your child to eat it than products that come with a straw or easy open cap.

5 – If all else fails and your child is simply not eating lunch, meet with your school principal and teacher to troubleshoot. Ask if you can observe a lunch period, volunteer during lunch, or work with an advocate to observe for you, so your child isn’t seeing you at school to watch lunch (they will most likely behave differently in your presence). Is your child last to get to the table, struggling to know where to sit, klutzy with the tray tasks, overwhelmed by noise, too excited to socialize to eat? Identify what is not working. Solutions might be quieter seating with a lunch bunch rather than in the cafeteria en masse, leaving two minutes sooner to get to cafeteria with a peer, or reliable seating at a regular spot. Further ideas are talking to your principal about aligning recess before instead of after lunch, expanding the lunch period by a few more minutes, or creating conduct rules at lunch for noise or behavior for the whole school. In my son’s elementary school, lunch included clear conduct rules that meant no one left the table until everyone had finished eating and had cleared their trays/lunch sacks and trash. This meant that at the end of the half hour (yes, they had 30 minutes), twelve little angels were usually seated quietly waiting for the signal for the whole table to go out and play. Rather than bench seating or loose chairs, the cafeteria had tables with single circles integral for each little behind, like this. These omitted crowding or jostling for space. Find power in numbers with other parents for these larger changes.

When I was a kid, we actually got bussed home in the middle of the day for lunch. My school did not have a cafeteria. We were picked up, brought home, I had lunch with my mom and siblings, and got back on the bus to go back to school. I had a full half hour to eat once home. I never felt rushed or worried about lunch. It’s hard to believe this is how it used to be in an American public school. Times have changed, budgets are squeezed, moms aren’t home to serve lunch. Maybe someday our school system will reboot how it does lunch time to something more conducive to learning, but until then, give your child these options to at least get through the day on more than fumes – they deserve it!

 

5 Must-Do’s For Your Children’s Health This Year

5 Must-Do’s For Your Children’s Health This Year

Let me tell you the five most helpful to-do’s I have seen parents use for their children’s health, as we start a new year.

These come from my twenty years’ experience working with families in my pediatric nutrition practice – with mostly complex, difficult cases who couldn’t find improvement elsewhere. In other words, even if your child is really challenged with feeding, growth, chronic illness or disability, developmental trials, allergy or more, I can tell you that these five tips are still my top picks, for setting up the healthiest foundation possible for your kids.

You might think I am going to talk about stuff like picky eating, junk food versus organic, gluten, food allergies, eating more vegetables, probiotics, vitamins, the latest autism protocol, whether or not you should do GAPS, gut biome… Nope. I definitely do cover all that and more in my clinical practice and in my blog, so have a look around.

These tips are about you – and how subtle shifts in your approach to health and what your family eats can cause unexpected benefits to unfold in everyone’s health.

1 – Get fierce about this: Adopt the mantra that health – not illness, disability, endless doctors’ appointments, or dependence on prescription or over-the-counter drugs that bring unwanted side effects – is your child’s birthright. It’s the baseline they are entitled to. Picture them at their healthiest and happiest. Imagine the unimaginable, if that is what it takes. Start with that picture of the joy good health brings.

If they’re not there, if your children are saddled with chronic illness, don’t lament, and definitely don’t feel sorry for them – they have you as their advocate and model, and they need positivity and possibility. Hold that image of total health that they need and deserve. Assume they have it already, and lead the way toward it, quietly and persistently. Expect a good outcome. Their bodies are built to grow, heal, and restore. There is always potential for healing.

2 – Chill out about food. Robyn Obrien’s 80/20 rule is a comfortable sweet spot. Her suggestion is to work for “progress not perfection”. Unless you know your child will sustain severe injury or consequences from eating certain verboten foods which must be avoided, don’t pathologize food. Don’t judge. Don’t chatter about how horrible this or that food is.

I encourage parents to use empowering language, even with small children. I discourage labeling food as “bad” or something that will “make you sick”. This can burden children – even teens – with unnecessary anxiety.

Instead, use words that show the power to choose. If your child eats something that backfires into discomfort or behavioral disintegration, ask which food might feel better next time, if they’re old enough to consider that question for themselves. If not, tell them what you will do next time: “Next time I’ll have xyz ready to eat instead, and you can see if that feels good”. Or “I’ll give your teacher a new snack for you at school. Maybe that will feel good instead.” Don’t harp on what a mistake a transgression was, especially if your child made the choice or if the choice was beyond their control. That is too easily internalized into feelings of powerlessness or failure by a child.

Notice your phrasing, demeanor, and tone when talking about food and health. Leave out the dark, judgmental stuff and emphasize food feeling good, tasting good, or being fun to share or experiment with.

3 – Read food labels? Now try this. If you’re like most parents I work with, you read food labels ad nauseam. You scrutinize every ingredient that passes your child’s lips – especially if you faithfully eat only organic food, avoid corn syrup or dyes, or if your kids ever needed an Epi Pen for eating the wrong thing!

Great. Now try this: Read a vaccine package insert. Read the whole thing, including the ingredients (often listed under the word “Description”). If you care about what’s in your child’s food, you will definitely want to know what is injected into them.

This is a great resource to see the full insert for each vaccine in the schedule. To see ingredients, search for the word “description” (which – as you may wonder – does not necessarily disclose all the ingredients, some of which are allowed to be proprietary, per the FDA).

I’ve met many a mom worried about letting their kids eat, say, corn chips or dairy (because they heard either was “bad” for everyone) – but never knew that Prevnar 13 – just one of dozens of shots on the schedule – has GMO soy fragments in it. Or that Recombivax has yeast, soy, formaldehyde, dextrose, and aluminum in it.

Recombivax is given to newborn babies. If you wouldn’t let even traces of GMO soy, formaldehyde, or aluminum touch your newborn baby’s tongue, why would you let these be injected? Note that eating any protein – or toxin for that matter – is far safer than injecting it, especially if your child is prone to any sort of reaction.

No need to dwell on what a contentious conversation anything with the V-word is, or indulge the drama and emotional reactions to this topic (I’ll delete comments that do). I get it. My graduate training in public health was full-on pro vaccine. I don’t need any instruction here, thank you very much.

It’s just that it’s high time for common sense. We talk a lot about food ingredients, including traces of glyphosate in GMO foods. Nobody talks much about ingredients in your kids’ shots. The “trace amount” argument loses traction once you see that kids receive anywhere from 70 to 100 doses in their first five years, when they are the most vulnerable to the burden of toxic exposures.

It would be fabulous if there was a pharmaceutical or biological product that actually was reliably, equally safe and equally effective for every kid or baby, every single day. But that is just magical thinking. There is no such thing, anywhere. Not a food, not a medicine, not even a fragrance. Can you imagine if it were mandated that all public school children eat Adderall every day, because some kids are too hard to manage in the classroom due to ADHD?

So this is why my Number 3 is for you to learn exactly what’s in your kids’ shots (or yours, if you’re planning on getting pregnant). They are potent. Don’t take them lightly. They may be helpful, or like anything else, they can be harmful. Too many may overstimulate the immune system to cause problems later on. Learn what is in vaccines, when they’re given and how often, and scrutinize if your child really needs them all.

For example: Your child won’t need boosters if they retain immunity from a prior dose – more may not be better.

If you’re upset because someone gave your kid a bag of Skittles at school, then wig out about the kid next door who skipped chickenpox vaccine, I think you’ve got it backwards. Just my opinion.

Besides, don’t you believe your own kid’s chickenpox shot worked – ?

In this scenario, the candy may be the lesser of two evils. Chickenpox vaccine is made with human fetal DNA, guinea pig embryonic tissue, sucrose, glutamate and MSG, and fetal bovine serum. Check out page 6 under “Description”.

4 – Heed your intuition. It’s a powerful healer, guide, and protector for your kids. And at the same time, remember that intuition is not a mandate for you alone to know everything!

In all my years as a clinician, I can’t tell you how many times I’ve heard a mom say “I just had a feeling” …and how often that feeling was right. I’ve certainly had that moment many times myself as a mom.

It can be tough to go against the advice of the expert specialist at the Mayo Clinic, but you can do it if you simply feel you must, even if you don’t know quite why just yet. You know your child best.

Don’t confuse intuition with fear, or with the egocentric idea that only you can help your child. While I’ve often seen a mom’s intuition impressively steer a child to a good outcome, I have also seen families withhold good care options or block alliances with good providers, out of fear that they shouldn’t trust anything, or a belief that only mom can know what to do. Neither approach is very successful.

Look for your allies and resources, know your own strengths as well as spots where you could use help, allow the help in, and remember – you do know your child best.

5 – Drop the drama. When we have kids with struggles, it’s so easy to be seduced by the drama of what it takes to be their parent.

It’s easy to over-identify with the tasks of caring for kids with learning disabilities, developmental concerns, feeding and growth delays, allergies, and more.

Don’t do that. It messes up your kids. They’re not here to fulfill you in some way, or address your needs. They’re just here. Pretty much, to be themselves.

I meet traumatized families. Families who have had too many trips to the ER for severe allergy reactions from an accidental walnut, for seizures because a medication keeps failing, for passing out because of FPIES reactions and non-stop vomiting (a broken arm sounds pretty good for these families). Families isolated by too many dietary restrictions, by developmental disabilities including autism, anxiety disorders, or processing disorders.

I meet families who have been verbally battered or treated with great insensitivity by doctors, teachers, neighbors, or even friends or family members. Trusting becomes hard. As a parent, it’s hard at times not to feel victimized, to feel like the hardship with your kids may never end, and to lapse into the trap of believing that this whirlwind of medical/developmental/educational crises is… your whole and sole self.

But this isn’t about you.

Underneath and in between all that, there is your child, endeavoring to just be. Like any other kid.

The kids who come out of these tempests with the best outcomes, in my experience, are the ones whose parents can remain aware of this. They do not attach their own pain, ego, fears, sadness, disappointment, frustration, or feelings of inadequacy as a parent to the child, or to the outcomes. They don’t focus on diagnostic labels, whether it’s eosinophilic esophagitis, PANDAS, autism, Crohns, FPIES, or whatever. They rarely if ever use the labels around their kids, because they know their kids are not the labels. They obtain the labels as a path to health and wellbeing as is useful – that’s it. They don’t spend too much time on Facebook groups devoted to their kids’ labels. They focus on actionable solutions. They trust the fact that as parent, they are doing the best they can.

You’re in charge. You set the tone. Your kids will follow suit, even if they have seemingly insurmountable challenges on their plates. I used to hate it when my mother advised, “don’t complain, don’t explain” …but, she was right.

 

 

What REALLY Heals Leaky Gut in Kids

What REALLY Heals Leaky Gut in Kids

Healing leaky gut is one of the most requested tasks in my pediatric nutrition practice. Many parents are surprised to hear me say that it is possible to repair leaky gut in children of all ages.

But what really works? There is a lot of buzz about dietary approaches, probiotics, and supplements, and less good research on leaky gut than we’d like, especially when it comes to infants, toddlers, kids, or teens. However, after twenty years in my clinical pediatric nutrition practice, I can tell you what nutrition supports I’ve seen consistently work, and what strategies often fail.

First, let’s get on the same page about what leaky gut is, and isn’t. It doesn’t mean there are actual ulcers or holes in your child’s intestine that are “leaking”. But it can mean that the intestinal wall has lost some integrity – and has become too permissive about the size of molecules that it lets pass into your bloodstream.

Another way you might hear leaky gut described is “intestinal permeability” or “hyper-permeability” – again, expressing a condition in which the intestine’s normally very selective, tight process for digesting and absorbing food has become, well, loose and sketchy!

Practitioners – myself included – might scrutinize zonulin, stool microbe studies (microbiology culture or PCR DNA methods), inflammatory markers like calprotectin, or immune markers like immunoglobulin A in a stool sample to gauge gut environment. Some doctors may order a lactulose-mannose test in which patients drink a concentrated solution made of those sugars. How these two sugars, which are different sizes, are excreted in urine can give a measure of how permeable the gut is. For more on intestinal permeability tests and their pros and cons, click here. Food allergy and non-IgE food reactions may also be measured, which requires a blood test.

Key To Restoring Leaky Gut Is….

Key to restoring a healthy gut is repairing “tight junctions” – these are the microscopic, traffic-cop structures of your gut. They form a tight seal between cells in the intestinal wall. When these junctions are injured, they break down – and larger-than-ideal molecules cross from the intestine into the bloodstream, triggering all sorts of reactions to stuff that your bloodstream and distant tissues were never meant to see in the first place. These might be anything from polypeptides (over-size fragments of food protein molecules that can masquerade as false hormones, false neurotransmitters, or invading antigens) to toxins, getting access your body from your gut, when they’re not supposed to. This permeability scenario is a catch-22, in that it can easily perpetuate itself, as more injury persists in the gut.

The intestine is our largest immune system interface with the world outside the body – so leaky gut can also wreak immune havoc, from autoimmune problems to frequent infections and illnesses.

What injures the gut? Lotsa stuff – and, making this harder is that leaky gut symptoms are often diffuse and insidious. They can evolve gradually, or with an abrupt onset that never quite resolves. Leaky gut can trigger symptoms in the GI tract of course, but also far from the gut, like headaches or joint aches, stiffness, pain, fatigue, or frequent colds and infections.

image courtesy Jill Carnahan MD

Here Are Usual Suspects for Triggering Leaky Gut

  • antibiotic use
  • intestinal Candida or other fungal species infections
  • undiagnosed food allergy or food sensitivity
  • intestinal flu or virus
  • food poisoning
  • non celiac gluten sensitivity
  • poorly tolerated routine vaccinations
  • chronic stress
  • traumatic brain injury or concussion
  • C section birth (baby misses exposure to helpful vaginal flora)
  • mom treated with antibiotics in pregnancy or at delivery for any reason
  • mastitis (mom needs antibiotics while breastfeeding)
  • radiation therapy
  • being underweight especially if you’re a baby, child, or teen

Most kids have had at least one of the items on this list. But that last one is key. In itself, underweight can cause intestinal permeability especially in children. You can address all the other triggers, but if your child is underweight – that is, more than fifteen percentile points off his or her expected pattern – your child’s gut can remain “leaky”. There simply isn’t enough raw material and energy on board for that tissue to repair itself, while your child is also trying to grow.

Here’s the rub: Generally, nobody scrutinizes your child’s growth pattern that closely (I will be honest and tell you that I even see gastroenterology work ups overlook this level of detail – and I routinely read my patients’ reports from their GI specialists nationwide). Without defining your child’s actual expected growth pattern – that is, where your child should be today given parental stature, pregnancy history, birth/delivery history, and growth history since birth – then you don’t know if your child is underweight or undernourished. You can learn more about that here.

I meet many children who are underweight. Sometimes it’s caused by families placing kids on diets that are too restrictive. Or some families have become so traumatized by frightening reactions to foods that they just don’t know how or what to feed their children – so, they don’t. Sometimes it’s caused by a well meaning practitioner who didn’t monitor growth and food intake, because they’re focused on lab tests and supplements instead, gave no guidance on what to actually eat, and encouraged a restrictive diet without effective replacements for foods taken out. I have also seen underweight caused by reflux medicines, which can diminish appetite and digestion when used for more than a few weeks or months. When it comes to picky eating, this too will drive growth status down in kids, injuring the gut too via underweight and poor diet.

The flip side of this coin is assessing what your child eats – how much and what – and the only way to discover if your child eats enough non-triggering, nourishing food is to assess a food diary  (part of every new patient intake I do), and then align it with the growth assessment. The food your child eats is the lumber that will be used to do the gut repair – so it has to be the right stuff, in the right amount. Supplements (including glutamine, which is a helpful amino acid but not an energy source), herbs, and probiotics don’t provide this raw building material. I meet a lot of kids who have been given a lot of supplements, lab tests, antifungals, special diets, and measures to repair leaky gut. But they’re still struggling – because this essential growth and feeding part gets lost in the shuffle. But put the right feeding plan with the right supplemental supports, and boom – now you’re talking!

Here’s What Works to Repair Leaky Gut In Kids

  • Balance gut microbe environment with herbal or prescription agents to directly address fungal burden, Clostridia burden (even commensal strains can be problematic if they far outnumber other helpful strains), Strep or Klebsiella, parasites, protozoans, and whatever comes up on testing. Combine this with probiotic supplementation that matches your child’s stool studies. My preferred tools for assessing this are GI MAP and Doctors Data Stool Microbiology.
  • Customize the special diet to your child. Skip dogmatic, one-size-fits-all approaches.
  • Give enough protein! Kids may need anywhere from 1 to 2 grams of protein per kilogram bodyweight per day depending on degree of growth impairment.
  • Give the right protein; assess first which proteins are triggering with lab studies. Replace trigger proteins with equal or better value non-trigger protein sources, and keep them varied.
  • Use free amino acids. Supplementing with amino acid mixes that give all 8 essential amino acids (and not just glutamine) has been a big bonus in my practice for kids who need deep gut repair. Formulas and powders are available. These give the gut direct access to building blocks for new tissue growth and repair. I use anywhere from 5 to 15 or even 30 grams daily of this protein source, depending on a child’s needs or status. Caveat: These won’t work well without an adequate total diet around them to support energy needs.
  • Give enough total food including “clean” (non sugary) carbohydrates, which are crucial for growth in children (carbs preserve protein for structure and function, and keep it from being burned for energy) and ample healthy fats and oils. Kids can need 4-6x more calories per pound than adults, depending on age and growth status. Don’t feed them like little adults – give energy-dense, nutrient-rich food.
  • Mastic gum, licorice root, zinc carnosine, glutathione, mineral-rich foods or products like Restore are just a tiny sliver of the thousands of products that can aid gut tissue repair. Work with a knowledgeable provider who has used these in children before. Using these tools is a routine part of my practice.
  • Correct sleep pattern so your child can sleep deeply and wake rested. Sleep is when our organs are busy with repair and clean up. Hint: Children who are underfed tend to sleep poorly and wake more often.
  • Minimize stress in your child’s world. Don’t discuss “leaky gut” with younger kids and don’t frame food or their bodies as problematic. Use positive language and emphasize the power to heal, which we all have.
  • Give it time (like, months), be chill, and remember that your child’s body is a miraculous thing with its own innate drive to grow, repair, and heal.

And Now For The Leaky Gut Fails…

  • Using rigid diet strategies for growing kids can be too restricting to support growth, gain, and gut repair. Yeast free diet, GAPS, ketogenic diet, AIP, SCD, Paleo, or Body Ecology all have merits (and devotees!), and I use components of all of them in my practice. But in themselves, none of these were created for use in children (except ketogenic diets for seizure control) and can fail when children are already struggling to gain or grow. If you’re not seeing good growth, gain, and progress in behavior or food reactions with one of these strategies within 2- 4 weeks, or if initial improvements lapse quickly, then it probably isn’t right for your child. Customize to your kid instead!
  • Needing your child to like any of this, including taking supplements, having blood draws, or accepting different foods. You’re the adult. They’re not going to make it easy for you – that’s a given. Hint: Picky appetites can improve with addressing these three steps – don’t assume your child “won’t eat that”.
  • Staying on reflux medicines for months at a time. These will work against your gut healing efforts by keeping pH in the stomach too weak to initiate good protein digestion. They will also cause your child to feel less hungry over time, to eat less, and to become more picky – thus leaving your child underfed and unreplenished for the task of gut repair. Learn more about the downside of reflux medicines here.
  • Using glutamine, vitamins, minerals, or lots of supplements before you situate the right feeding strategy for your child. Feeding strategy means knowing what foods to use, how much and which sources of protein, fats, and carbs, and for how long, to support your child’s expected weight and height.
  • Being aggressive with fermented foods, probiotics, or too much Saccharomyces boulardii. These can backfire if used for too long or at too high a dosage, and may even start to create their own dysbiosis or discomfort.
  • Leaving fungal, parasite, SIBO or SIFO, or other dysbiosis untreated or under-treated. This can interrupt appetite, digestion, and stooling and keep tight junctions from sealing up.
  • Giving up after 2-4 weeks. This is a restore and repair effort that may take months, depending on how long your child’s gut has been in the weeds.

Want help? This is a lot! Let me sort the best options for your child. Contact me today to set up a time to work with me remotely or in person. Or, peruse my options for books and on-line-course support.

 

 

 

 

 

Five Things Your Pediatrician Doesn’t Know About Nutrition

Five Things Your Pediatrician Doesn’t Know About Nutrition

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 mostExpect 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!

 

 

Your Kids Get To Be Healthy

Your Kids Get To Be Healthy

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.