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Are Ketogenic Diets Good For Kids?

Are Ketogenic Diets Good For Kids?

I’m often asked if ketogenic diets are good for kids. Parents are trying this diet and having great results – why not put the whole family on a ketogenic diet?

It doesn’t take much searching to learn that ketogenic diets have been vetted for nearly a century, when they were first noted for their ability to control seizures. Even conventional training for dietitians has included training in ketogenic diets for decades – they’re not new.

The new part is using them for weight loss, fitness, and all sorts of chronic conditions, from cancer and autoimmune problems to Alzheimer’s, multiple sclerosis, or autism. You’ve probably seen experts – from Mark Hyman MD to David Perlmutter – singing the praises of ketogenic diets. But what about your kids? And, what about using a ketogenic diet for kids with autism?

Ketogenic diets use high amounts of fats and oils, lots of protein, and very little carbohydrate. Typically about 70% of all the food you eat on a ketogenic diet will come from fats and oils, with only about 5% coming from carbohydrates. By contrast, kids usually eat anywhere from 50-70% of their total diets as carbs, with 20-40% as fats – so this is a big switch.

Research is mounting to show that eating this way changes the bacteria that grow in your gut. By now, you’ve probably heard about how deeply we rely on gut bacteria for overall health. Gut bacteria are essential to our well being, in that they help us digest and absorb the nutrients we need. They also cut inflammation and protect us from invading pathogens – that is, if your gut bacteria profile is healthy.

This is critical in early infancy too, to avoid conditions like allergies and asthma later on. And gut bacteria play important roles in other conditions that have been regarded as exclusively psychiatric or neurological for decades, including autism – but for years, I have helped families reverse behavior and developmental concerns in their kids by restoring a healthy gut biome. Now research is finally mounting to show that this is indeed possible!

If you have a lousy gut bacteria profile (which you can acquire by eating a junky diet, or using antibiotics, reflux medicines, and steroid anti-inflammatories), chronic and systemic problems are likely going to ensue. It’s popping up all over the academic literature landscape, and I’ve seen it happen before my eyes in practice for years: Nasty gut flora = nasty kids, nasty poop, nasty behavior, poor eating habits, and chronic health problems!

Anytime you change your diet, you will change the bacteria in your gut, in about 2-3 weeks. Ketogenic diets change gut bacteria too, and it is through these changes that this diet can support renewed health. Ketogenic diets also change our body’s primary fuel from glucose, which is obtained by eating carbs, to ketones, which are obtained by eating mostly fats and oils. The brain, and all our organs and tissues, can run well on ketones. When the body is using ketones all the time, this is called being “in ketosis”, a goal that is closely monitored for people who use ketogenic diets to control seizures. Even tiny amounts of carbohydrate can trigger a seizure for some people with epilepsy. Being in ketosis is when seizure control can happen best, for people who fail on seizure medications.

But ketogenic diets for kids may have a cost. They may not grow as tall as they would if eating a diet with more carbohydrate in it. This was noted in this study in children using ketogenic diets. The children’s progress for linear growth (that is, height or stature) slowed down after 15 months on the diet.

This may be partly due to changes bone density. Effects on bone development were closely scrutinized in this study, which found reduced bone density with ketogenic diets for kids.

Effects like stunting from ketogenic diets for kids have been observed for many decades, and I have witnessed this myself in my pediatric nutrition practice. Kids who come to me already on a ketogenic diet follow what occurred in this study, that also saw slowed growth for height and weight in children using ketogenic diets. And in this study, the number of children who fell below tenth percentile for height more than doubled, from ten to twenty-three children, while using ketogenic diet. They also had more than expected kidney stones and bone fractures. Children also may gain weight more slowly on ketogenic diets, impairing their growth pattern for both weight and height.

Slowed growth is not just a physical issue. It can have cognitive, functional and behavioral impacts too – and this another often-seen issue in my pediatric nutrition care practice. Ketogenic diets for kids may thus create unwanted cognitive effects, as described in this study on developing rats. In my practice, one of the most common findings for school children with ADHD/ADD is that they are underfed – ironically, often because they have been using a stimulant medicine that suppresses appetite. Eating poorly, they fall in and out of ketosis during the school day and disintegrate behaviorally for focus. Their food intakes need improvement, but being in ketosis does not seem consistently helpful.

These impacts may not be a concern for adults on ketogenic diets. This very small study of only three individuals did not find changes in bone density after five years on a ketogenic diet. This study of sixty-five adults saw reduced bone density in groups using either very low carb or calorie restricted diets for weight loss, but it’s unclear if the subjects sustained ketosis or not, or if bone density dropped simply because subjects weighed less at the end of the trial.

The Up-Side of Carbs

Carbs have been demonized for sure, and not without cause. I have seen thousands of food diaries over my years in practice for infants, toddlers, kids and teens (thank you to all those parents who filled those out with dispassionate honesty!). Without question, many kids I encounter come in with carb-heavy, low quality diets that rely too much on processed grains, sugary yogurt, juices, or starchy crackers and snacks. Not good.

But there is an up-side when eat kids about a third to half their calories from clean carbs. Kids are growing. Adults aren’t. When we’re growing, carbohydrates from food we eat spare the protein and fat we eat, so that they can be used for other critical tasks – both metabolic and structural – that adults simply don’t have because they’re not growing.

A child needs a lot more energy per pound than an adult. Depending on a child’s age or growth status, they can need as much as five times more calories per pound than an adult! This could be the same as you or I eating ten thousand calories every day, just to maintain a normal healthy weight (imagine what would happen!). Strangely, even when kids use calorically adequate ketogenic diets, they can still experience stunting.

This might be related to the fact that kids’ brains use about double the amount of energy every day compared to an adult’s brain, in terms of the percentage of energy derived from the food you eat. This is true until about age four, when head growth slows down relative to the rest of the body.

Long short, adults aren’t growing, and thus don’t need a sparing effect from carbohydrates.

The big caveat here is that kids need clean carbs. When kids eat healthy, clean carb sources with good protein and ample varied fats, they grow well, and behave, sleep, and learn well too – I’ve seen this hundreds of times. “Clean carbs” are unprocessed, no-added-sugar, whole foods. Think vegetables, legumes, and tubers – parsnip, squashes (butternut, acorn, spaghetti squash, zucchini, pattypan), asparagus, cruciferous vegetables like Brussels sprouts, broccoli, or cauliflower, carrot, potato or sweet potato, greens, lentils, chick pea or beans, green and wax beans, taro, or manioc are all carbs to have on your menu rotation. They provide pre-biotics for your gut bacteria to work with for healthy fermentation in the gut and nutrient production, not to mention their bonus of minerals. Fresh unsugared fruit (not fruit juices) is helpful too. When it comes to grains, sprouted grains will be more digestible, but grains are by no means absolutely necessary in your child’s diet.

One not so great carb is yogurt – because yogurts for kids are generally loaded with added sugar or sugary fruit. Most yogurts on store shelves have far more sugar in them than fat or protein, so if your kid chugs drinkable yogurt tubes or even a non-dairy yogurt cup daily, switch to a no-added sugar option and use a drop or two of organic stevia to sweeten it if need be.

But Babies Are Born In Ketosis! So…Doesn’t That Prove Ketogenic Diets Are Good For Kids?

When babies are born, of course they’re in ketosis – they’re not eating anything yet at all, and need a fuel to carry them through what may be hours of labor. Ketones work great. A young baby (a month old or less) relies often on ketones to fuel the brain for its first few weeks. Ketones are preferentially allowed into the delicate new brain over glucose as an energy source in that first month too. This is when “early milk” or colostrum has more than twice as much fat in it than it does carbs. Does that mean ketogenic feeding is the next rage for babies and toddlers? I don’t see it. By the end of the first month, breast milk nutrient ratios shift, so that it’s nearly 40% carbohydrate, and this doesn’t change much even for moms eating ketogenic diets. In other words, after that early milk, we evolved to give our babies 30-40% of their calories as carbs in the first year; our bodies will preserve this ratio in our milk no matter what we eat.

For infants or kids with seizure disorders, ketogenic diets can be miraculous. They are definitely worth trying and definitely warrant professional guidance. They may work because they do change gut bacteria, and eating any carbs – even clean carbs – above 20-60 grams/day  (which is quite low) may trigger relapse of seizures. Follow your care team’s advice if this is your situation.

Ketogenic diets that are poorly monitored can be dangerous. I don’t recommend launching one for kids without professional guidance. If you have, watch for these warning signs of hyperketosis: Rapid, panting breathing; rapid heart rate; facial flushing; irritability; vomiting; or unusual lethargy. If you see those signs, call your doctor right away or go to your nearest emergency room.

For kids with autism or other conditions, there are options to tailor ketogenic diets to each child so that functioning improves dramatically, without compromising growth, bone health, or kidney health. This is one of my practice offerings, so contact me if you need help. And if you’re still laughing about that long list of veggies that your kid would never eat, let’s get in touch to work on that. Changing that gut bacteria profile can change your kids’ palate and appetite!

 

Grazing Versus Meals: What’s Best For Kids?

Grazing Versus Meals: What’s Best For Kids?

Which feeding strategy is healthier for kids – grazing as they please, or structured meals? I get asked this a lot. Here’s what I’ve experienced across some twenty years in clinical practice with all ages of kids, from young infants up to twenty-five year old young men who are finishing their last growth spurts. This question goes not only for meals, but breastfeeding too, especially when infants are wrapping up that first year or so, and becoming very interested in eating what they see you or their siblings eat.

But here’s the thing: The question you really need to start with is, what is best for you?

You may already know that supplying a steady stream of snacks and mini-meals isn’t nourishing for kids, and it’s a lot of work. Are you up for that? How about if you have three kids with different food allergies, not to mention different activities in different directions all day long? Or if your spouse doesn’t “believe” in all the effort you make to feed everybody, wants their own special favorites, and leaves it all on your shoulders? Mix in work schedules and budget constraints for special foods, and this becomes a fail, fast – one that I have witnessed many times in families reaching out for my help.

Usually, kids in these scenarios aren’t thriving. They’re often underweight, cranky, manipulative, poor sleepers, and picky eaters. And the chef-parent is at wits’ end. If you can’t keep up this workload, or if you plain just hate doing it, then it’s simple: Stop. Your happiness matters, period. And, happiness rubs off on your kids. And and, your kids will be healthier with discreet meal schedules, versus growing up on the non-stop graze.

As exhausting as feeding a grazer can be, it’s an easy trap to fall into. There are so many ready-to-eat packaged foods now for toddlers and children, that just handing over that pouch of organic veggie goo, paleo power bar, yogurt tube, or cup of snack crackers when you know your child probably isn’t eating enough is too tempting. But giving in to grazing has problems:

  • It may worsen small intestine bacterial overgrowth (SIBO) or small intestine fungal overgrowth (SIFO), a frequent cause of picky eating, weak appetite, and poor growth and gain for toddlers in my practice. Brief periods of day time fasting help keep this under control. Toddlers can manage two to three hour stretches between meals or snacks; school age kid, up to four hours or so.
  • Missing those short fasts throughout the day prevents an important thing called the “migrating motor complex“. This is what our GI tracts do between meals, when we’re on empty. It’s a housekeeping function that literally acts like a mini-cleanse broom, sweeping the intestine, and making it hard for lousy SIBO or SIFO microbial garbage to set up house.
  • When the body is fasted, the muscles in the small intestine make a wave of forward motion. This cleansing wave keeps intestinal contents from getting stuck – which is better for that constipation scenario you may be dealing with (read my blog on how to get off Miralax if that’s your kid). Eating too often abruptly ends this task.
  • Grazing can leave toddlers and kids hungry in the middle of the night, causing them to sleep poorly, wake up tired, or cry for a feeding when they’re old enough to sleep through – if they get the food they need during the day.

Some other points to consider

  • Eating is self-care. Kids learn good self care from parents who model health and happiness habits. If you’re miserable dealing with food and preparing meals, your kids will adopt a view of food as a burdensome annoyance too. Don’t expect them to lead the way here or make it easy for you – that’s your job.
  • Perhaps your toddlers (or kids) are good at grabbing what they want to eat, when they want. How independent is that, right? And maybe that makes your day easier. But, they’re toddlers. They are still dependent on adults to make wise decisions about what foods are good, and when. Left to their own devices, they’ll mostly eat what’s familiar, and not explore new foods that they may need, as they grow so rapidly.
  • Up until just a few years ago, there were none of these packaged foods parents now find so irresistible: The squeezable pouches of yogurt, fruit, and veggies; the packages full of crunchy snacks designed to be held by toddler hands; the endless variety of power bars, paleo bars, protein bars, and snack bars; the mini cups of chia pudding or vegan spreadable cheese or hummus; the gummy snacks that are fruit-like, sort of. All of this has been created for one reason: You buy it. It’s profitable. Kids definitely don’t need any of this stuff to be healthy, but if a bit of it in the mix makes life easier, enjoy – just don’t make it your only food strategy.
  • Learning to respond to hunger and fullness healthfully only happens when kids actually experience these things.

Avoid These Sure-To-Fail Scenarios

Recently a mom asked for my help with the breakfast routine for her three kids. One child especially did not want to eat in the morning, then went off to school semi-fed, where he proceeded to have meltdowns.

“Tell me the sequence of what happens; what is the first thing he does when he gets up?” I asked.

She explained that this one of her brood would get up, and immediately settle into Lego play before breakfast, which he would vehemently oppose leaving behind for food. He’d attempt some eating in this disintegrated state of mind, fail, and go off to school blunted for hunger but not well fed.

First step: Lose the Legos. Morning on school days is self care time, not play time. It’s get-ready-for-your-day. It’s fuel-up and settle-down for the tasks ahead. Toys should be nowhere in sight. This may sound hard, given the absurdly ubiquitous nature of branding for toys on everything from pillowcases to toothbrushes (not to mention snack food!). But it’s a self care routine that must be learned. Kids will not become good planners when toys, snacks, and whatever else they desire is within reach at any moment.

Another very common fail I encounter is prolonging breastfeeding. Don’t get me wrong: We all know how amazing breastmilk is. But, as infants age out toward their second year, they need some solid food too. I have met countless moms afraid to wean, for a variety of reasons. It’s  misguided to think that breast milk will continue to be the solution as their babies become toddlers. Their kids sip sip sip. They want feedings at midnight, 2 AM and 5 AM even though they’re 13 months old. Fail. This is a kid who needs to start eating food.

Continuing to breast feed is fine – but it should not be the only or primary source of sustenance at this age.

Even if your youngster is doing great at 14 months on just breast milk, I’ll bet you haven’t had a full night’s sleep in a long time. No good. You need sleep. Baby needs food. Solid foods needed for the baby’s higher demands get displaced with constant sipping on breastmilk, which can stop being adequate to meet all of a baby’s needs by about age 10-12 months. This can vary with circumstances for the baby, so finding the fit for you and your baby is key. It might be different from someone else.

If your child is fiercely picky for just breast milk, sleeping fitfully, waking for feedings, and failing to progress with introducing foods after age 15-18 months, it’s time for some intervention and redirection –  call me for an appointment.

Ok, one more: Just like toddlers, older kids need guidance and modeling for healthy self care habits when it comes to food. Teens who skip breakfast, breeze through lunch with a power bar, chow hard at dinner, then eat big again at midnight are setting themselves up for a bunch of challenges for mood, energy, attention/focus, and sleep. If they’re struggling, and combative about food, let’s talk. Most teens I’ve worked with are relieved to be offered options that lift this burden and give them strategies they feel better with quickly. The trick may be hearing it from someone other than mom or dad.

Need help? Work with me to sort out what food your kids need, when, and how!

Surprise! Your Child Is Underweight

Surprise! Your Child Is Underweight

 

Is your child underweight? Your doctor would have told you, right?

Maybe not. In fact, I am often the first person to capture this finding in a toddler, child or teen who has seen multiple providers, from the pediatrician to gastroenterologist to allergist and so on. But this is really important for kids. Why? Because once kids slide into growth impairments, it throws a lot of other stuff off kilter for them. One, their immune systems don’t work as well. They can get sick more often, stay sick longer, and have more complications from infections than kids in healthy status. Two, they struggle more to behave, learn, focus, or sleep, and will often experience more anxiety, less self regulation, and more mood swings. This can happen even with mild or moderate growth impairments. In other words, kids don’t have to be severely underweight for this stuff to go wrong. When kids finally hit bottom with that failure to thrive (FTT) status, this will create a leaky gut – something many parents ask me about – because there aren’t enough nutrients and energy from food for the child’s gut wall to maintain its integrity. And, the younger a child is, the more vulnerable they are, when dropping off channel.

Pediatric providers generally won’t intervene on or even mention a lagging growth pattern unless your child is really, really underweight, as in – heading for the very bottom of the growth chart. Why not? There are several reasons why this can be true:

  • Your insurance may not pay your doctor to intervene on any growth impairment other than failure to thrive (FTT),  a severe and entrenched problem in which a child has fallen to below the fifth percentile for weight for age.
  • Your doctor may not know that dropping just fifteen percentile points off expected growth pattern, for either weight or stature, actually means your child is underweight or undernourished.
  • Your pediatrician may not know how to calculate your child’s ideal body weight, expected weight, or expected height, or doesn’t have time to do it.
  • Your doctor doesn’t have time to scrutinize, integrate and explain all the growth data in that brief fifteen minute visit, including all the things that impact growth, from your kids’ food intakes to energy level to genetics.
  • Your doctor isn’t sure how to help you fix the problem, or why it’s happening in the first place, if they notice it.

Because I work with kids with problems like allergy, autism, FPIES, inflammatory bowel conditions including Crohn’s disease, or all sorts of circumstances in which they can’t eat regular diets, it’s common for me to find that a child is indeed underweight. Many parents who contact me have placed their kids on special diets on their own, and don’t realize their kids are underfed and malnourished, even with all the best efforts at feeding well. But it can be a relief to know exactly what and how much food your child needs to grow, feel, and function better.

Usually, parents are downright surprised at what a difference something as simple as the right food intake makes for their kids. This quote is straight out of clinic today from a mom regarding her fifth grader, who had severe attention and focus issues for which he’d used medication, difficulty with independently toileting (constipation, stool accidents), frequent infections, and felt unhappy or frustrated often:

“Looks super healthy, I’ve never seen him this healthy. He seems more like a regular kid. He is thriving. He is growing like a weed. He is happy.”

This boy is off stimulant medication, using the bathroom independently and not having accidents, and has not had any infections for months, for the first time in his life.

What would your pediatrician do for these problems?

He would do what had been done for this child, and failed: Give methylphenidate (stimulants like Focalin, Ritalin, etc) for inattention and hyperactivity; Miralax for the constipation; antibiotics for the infections; and a “he seems fine” shrug for the moderate drop off of expected weight for age.

Nutrition care is not a replacement for medical care – and vice versa: Medical care is not nutrition care. They do different things, and require different skill sets. Strong nutrition in kids makes them healthy; prescription drugs mostly avert acute problems. Neither replaces the other, both are important for kids – but, unfortunately for kids all across the US, nutrition is not a big player in pediatrics nowadays.

Is your child underweight? Is it impacting their health? It’s easy to find out. There are well established criteria for determining things like expected growth pattern for a child, and how to restore it if lost. There are many tools at my disposal too, to sort out what foods would best serve your child, what foods you might really need to avoid, and what foods you really may not have to worry about. If you’re not sure, schedule an appointment and we can just find out!

Can Kids Eat Sprouted Wheat Bread On A Gluten Free Diet?

Can Kids Eat Sprouted Wheat Bread On A Gluten Free Diet?

Ezekiel and sprouted wheat breads are taking off in the ancestral diet department – but does this work on a gluten free diet? Spoiler alert: Sprouted grains, while containing less or different gluten from modern wheat, are not gluten-free. And even old land-race or ancestral strains of sprouted, organic, fermented wheat may be poorly tolerated in a modern-day injured gut. We have different wheat nowadays, and different guts!

First things first: What is sprouted wheat? Sprouted wheat bread is simply bread made with the seeds of wheat that have been soaked in water until, you guessed it, they sprout. Then the sprouts are ground into “sprouted flour”, used to make bread. Sprouting breaks starches down so they are easier to digest. Sprouted seed flours contain less gluten, but aren’t gluten free.

You can sprout all sorts of grains or even legumes, including barley, beans, brown or white rice, amaranth, lentils, millet, spelt, and more. “Ancient” grains – those cultivated millennia ago – include farro, spelt, quinoa, amaranth, chia, sorghum, freekeh, teff, millet and eikorn.

By comparison, non-sprouted grain breads simply use flour made from grinding seeds into flour.

In the case of wheat, grinding and refining non-sprouted seeds retains a lot of gluten – great for that doughy elasticity we so enjoy in stuff like dinner rolls or doughnuts, but bad for gluten-sensitive people.

 

We Eat Different Wheat Now

As you may have heard, wheat has changed a lot in the last sixty or so years:

  • Wheat crops grown in the US today were modified through cross breeding in the 1960s to have even more gluten
  • Decades before that, modern milling techniques stripped wheat of much of its nutritional value.
  • Pesticides weren’t used at all on crops until the 1940s; now US wheat is one of the most heavily pesticide-laced crops on earth, because glyphosate (RoundUp) is doused on it just days before harvest, to ease harvesting and processing.
  • Soils today have become depleted by modern farming techniques, leaving wheat even more bereft of nutritional value.

Besides the fact that modern wheat is now more refined, less nutritious, and higher in gluten, all of which make it harder to digest and more inflammatory for the human gut, the pesticide part really matters too. If you haven’t already heard, glyphosate damages the human gut biome, is suspect for exacerbating the autism epidemic, and may even trigger gluten intolerance or celiac disease itself, by virtue of its synergy with other toxins in our food and environment.

 

We Have Different Guts Now

So this means that the “can-you-eat-old-timey-wheat” question has two parts: While humans enjoyed organic, sprouted, fermented or even just plain ground wheat from ancient seed strains for centuries without injury (part 1), humans have not used glyphosate, exposed themselves routinely to heavy metals and industrial toxins, or repeatedly injected viral antigens into themselves year after year ever before (part 2). These can conspire to damage a gut beyond tolerance for even the loveliest of ancient or sprouted grains.

For the first time, we are eating and exposed to hundreds if not thousands of toxins that we never have been before, from pesticides like glyphosate to artificial ingredients in medicines and food to environmental pollutants. These all have potential to injure gut health and trigger inflammation. Glyphosate has been found in just about everyone, in breast milk and urine samples.

 

Our Viral Exposures Have Changed Too… A Lot

Viruses have long been suspect as a trigger for inflammatory bowel diseases including celiac disease. Meanwhile, viruses and heavy metals can synergize each other – that is, the two together can injure gut microbiota or worsen viral infection more than either alone (as in this example and this one). Like it or not, we have tinkered with these exposures with immunizations over the last six or seven decades too, by blending viral antigens in shots with metals like aluminum or mercury to “irritate” the immune system so that the shots work better. How these metals actually work in shots and what their cumulative toxicity may be, especially for infants and children, are not well studied.

Besides introducing vaccination in the 20th century, we also introduced exposures to toxic metals and pollutants from other types of pesticides besides glyphosate, and from large scale, mechanized extraction and manufacturing processes like strip mining, fracking, drilling, the use of plastics, and more.

So what this all means is that returning to ancient grains may not work for gluten sensitive kids, especially if they’ve had usual vaccinations (which gives multiple viral exposures in quick succession early in life with toxic metals), antibiotics, stomach flu bouts, or other potential disruptors to healthy human gut function and gut microbiome.

 

Ok So NOW WHAT?

Some gluten sensitive kids may be able to incorporate sprouted grain breads into their daily diets without an issue. Here’s how to sort it out:

  • Find out which grains your child is most sensitive to before stocking your kitchen with sprouted or ancient grain options, especially if there has been a diagnosis of eosinophilic esophagitis (EE) or food protein induced enterocolitis syndrome (FPIES). I use ELISA IgG food antibody testing for multiple grains in my practice, including spelt, millet, oat, barley, and gluten.
  • Run a urine test for glyphosate. This is available here. Work to reduce it by switching to organic foods as much as possible, while improving your child’s detoxification capacity. I work on this piece often with parents in my practice.
  • Run a stool test for microbiome profile. Several options exist for this, from extremely detailed genetic analysis for microbes found, to simpler cultures, to panels with or without inflammatory bowel markers like calprotectin or lysozyme. I offer these in my pediatric nutrition practice. Include the inflammatory markers if your child has been symptomatic for a long time, if s/he isn’t growing well, or if s/he has had multiple rounds of antibiotics or frequent infections.
  • Give your child upstream work first – a strong, nourishing, replenishing diet without any gluten (or grains if possible) for a good six months. You should see weight gain, strong nails, good dental health (no cavities), no rashes, and comfortable daily eliminations. Constipation, eczema, dentail cavities, or frequent sniffles are signs that you have more work to do. Don’t sacrifice growth or gain – kids need to follow their expected patterns for these, so don’t over restrict.

Need help? Get in touch, set up an appointment and let’s get started. Thanks for stopping by.

 

 

 

 

Fast Feeds! How To Feed Your Kids Good Food When You Don’t Have Time

Fast Feeds! How To Feed Your Kids Good Food When You Don’t Have Time

I spend hours each week researching products, recipes, and meal strategies for my very special pediatric clients. I also live in Boulder, Colorado – ground zero for foodie start ups (even my son’s baby sitter started a food company whose products are now in Whole Foods and other store shelves!). Just about every time I go to the grocery store, there is an interesting new product to check out around here.

Whatever I can find on store shelves right down the street, you can find on line. There’s no excuse to miss out on healthful, real food for your kids, even if you’re short on time and your kids have special diets or food allergies. Here’s my latest favorites for parents who don’t have time to bake, cook, or prepare scratch snacks. I often post new finds on my Nutrition Care Facebook Page too, so be sure to follow me there!

Tres Pupusas – Years ago I ate these delicious pupusas hot and freshly made at our Farmers’ Market. Now they are on store shelves, in the freezer section. Gluten free, organic non GMO masa (corn) flour pockets, with options from vegan (dairy and gluten free) to meaty (carnitas) or with cheese. Nicely sized for little kid hands (there’s even a bite sized mini pupusa), they make good finger food. Throw in a dip for your kids’ snacking, like avocado, hummus, or salsa.

Feel Good Foods – This is a good go-to for teens or college kids who have a microwave or hot plate and big appetite. This company’s egg rolls, potstickers, and other good stuff are gluten free, with several dairy free options too. Tasty if you have time to heat in your regular oven too. The pot stickers even come with their own gluten free dipping sauce. Have them ready when your starved kids come home from school starved, mad, and ready to kill you because they didn’t eat all day.

 

Capello’s Foods – Here’s an interesting line up of products: Gluten free, grain free manchego pizza, pastas, and… cookie dough?! If you can’t scratch-bake those lovely hypoallergenic cookies for the classroom party or your kids just like eating cookie dough, you have that option. And pizza – so missed by kids who don’t do dairy – can often work with manchego cheese (sheeps’ cheese), which some kids tolerate when they do poorly with cow’s milk or even goat cheese. Capello’s pizzas are the real deal – delicious, and you can build in more toppings if your kids like – chopped olives, basil or spinach leaves, bell peppers, or pepperoni. Almond flour is the base for these products.

CauliPower – This cauliflower crust pizza has taken the media by storm. Several topping options, with a crust based on cauliflower, and crazy good. All have cheese, but you can buy just the crust and build your own (try this cheeseless combo: Tomato sauce, salami, chopped olives, fresh basil leaves, scallions, oregano sprinkle and olive oil drizzle). Throw it in the oven 15 minutes before kids get home from school and you’re good to go.

Chebe – This product has been around for years. For Paleo, grain free, or gluten free diets, it’s a winner for giving your kids a sense of “bread”. It is basically tapioca flour, boxed as a mix, to which you add an egg, some vegetable oil, and liquid (water or almond milk). Period. I know a few noses will wrinkle at the thought of tapioca flour as Paleo, but the fact is, one of the biggest mistakes I see when kids go Paleo or GAPS is that they are underfed, their growth slows down, and they get cranky – usually because they’re eating too much fermented food, too much protein, and not enough good carby stuff. Kids do need carbohydrates to sustain normal growth patterns, sleep, focus, and to not feel anxious all day. So try this fast-to-prepare item and shape it into rolls, breadsticks, buns, or focaccia. Mince in some peppers or scallions. Plain, with herbs, slather on butter, ghee, olive oil, nut butters, or cut into awesome sliders and stick in a slice of prosciutto with mustard.

There you go – Five mostly heat-and-eat goodies to get your kids fed easily when you can’t prepare much of anything. Be sure to check each of these manufacturers pages for recipe ideas with their products too. Enjoy!

The Truth About Feeding Clinic

The Truth About Feeding Clinic

This will make a lot of people mad:

Feeding clinic may be a waste of time and money

Not at all to diminish the important work and skills of occupational and physical therapists. They work hard at helping kids learn to chew, swallow, touch, and tolerate the act of eating – kids who are tube fed, kids who’ve never mastered chewing by age four or six years, kids who only drink but can’t eat, kids who gag and vomit to different food textures, kids who stop eating at the slightest interruption or sudden sound, kids who are in growth failure because they can’t eat. This is important work.

But there are important underlying triggers for these feeding problems to rule out and repair, before you spend thousands on sessions in which you sit behind a two way mirror and watch your child try to touch whipped cream, corn chips, and broccoli with peers, before the rigorous home sensory protocols before each meal (trampoline, Nuk massage, Wilbarger protocol), not to mention stringent food routines at the table.

If your child has had a traumatic brain injury, a spinal cord injury, began life on a feeding tube, or has a physical or developmental disability that impedes feeding skills, then of course rehabilitative therapy is in order.

And, after you’ve been through challenges unimaginable when you became pregnant – that is, the challenge of your kid actually not being able to eat, gain, and grow – and your child has suffered, you’ve been to every specialist, and you know your local children’s hospital hallways backwards and forwards, it can feel downright offensive, insulting even, that there may be something simple, overlooked, that could fix this. Wouldn’t your team have told you?

A lot of parents get stuck right there. They outright reject that a solution as simple as correcting nutrition and digestion first could be a thing. Unless this is a complex, inscrutable drama that requires ivory tower specialist care, and week after week with an occupational therapist, a lot of folks feel like bad parents. So they turn away from the simple.

Don’t!

Forgive yourself for not knowing. Forgive your care team. Occupational therapists, GI doctors, and even pediatricians are not nutritionists. This isn’t their purview. If they had known, they would have told you, of course!

For kids who go from infancy to preschool with a mysterious lack of progression for feeding skills, screen for underlying physiological triggers that can keep your child from being able to swallow, chew, and eat normally. Even for kids with physical disabilities and complex conditions who benefit from feeding therapy, footwork on these underlying interlopers can make eating work even better.

Also, know this: I had one of these kids. Been through it, seen it, worked with OTs and PTs (some fabulous, others not so much). I know the trauma, cost, and stress that accompanies this situation. And, yet another mom just left my office today, telling me with deep exasperation what a waste of time (and money – thousands of dollars, not covered by insurance) it was to send her young son to a renown feeding clinic, for months, carefully following instructions for the home plan too, only to get feeble progress out of it at all. Is this you?

Before you go through costly, strenuous therapy that may inch your child forward, but not quite produce the progress your child deserves to grow, thrive, and just plain enjoy food – investigate these problems. Your child will be healthier, because they will be able to digest and absorb food more comfortably.

Nutrition and digestive problems turn kids into picky eaters

Fix these, and their appetites can quite abruptly improve. If you need help fixing these, schedule an appointment with me. You may see changes in as fast three to four weeks, depending on your child’s condition at start, and your compliance with a nutrition and gut health care plan tailored to your child. Here we go:

1 – Fungal Dsybiosis: Your child may have had thrush, you may have had a C section, maybe there were antibiotics in the mix for you while pregnant or breastfeeding, maybe you have a lot of yeast infections in your past, or maybe your child needed antibiotics early, often, or both. Whatever. Somehow, your child may have been left with a fungal burden somewhere in the digestive tract. What this does is (a) buffer the stomach so it is less acid, which makes you never feel that hungry (b) constipate you so you never feel like eating because you are always full of ______ (c) give you serious cravings for very few foods, namely, starchy sweet stuff, or dairy food and (d) bloat your belly. Solution: Screen for fungal dysbiosis with stool or urine testing; ideally include Candida and Saccharomyces antibody testing too (blood tests). Give a protocol to drop the fungal burden and restore healthy gut bacteria balance.  Your kid will feel more hungry, poop more regularly, and will want new foods, usually in about 3-4 weeks. Other nutrition measures may be needed, but this is a foundational piece that can relentlessly dog kids’ appetites. Note: Probiotics can help, sort of. The stuff on store shelves is usually too low potency to make a dent for kids who truly have a significant fungal burden in the gut. If you’ve used them and your kid is still picky, they’re not working, and you need a deeper strategy.

2 – Bacterial Dysbiosis: Your child may have a bacterial imbalance in the stomach, upper small intestine, or colon. This can make eating very uncomfortable. The small intestine normally harbors little bacteria; when too much is there, kids can have a lot of trouble eating. This will continue until these infections are treated. This is called Small Intestine Bacterial Overgrowth (SIBO), and your doctor may need to prescribe antibiotics to treat it. Some herbal treatments work well also;  probiotics can make it worse. Kids with bacterial dysbiosis feel full quickly. They may gag, or vomit violently, even to the point of shock (they go limp, become pale, you may have even rushed them to the ER where they needed IV fluids – this is FPIES) if they eat the wrong foods. Pressing children to eat when an infection is active in the gut is truly unnecessary and will be unsuccessful too. Solution: Talk with your GI doctor or pediatrician about possible SIBO. And, do functional stool testing such as GI MAP (one of the tests I use in my practice) to identify what microbes may be interfering. This test can give detail on what your child needs to balance bacteria in the digestive tract, so they can eat and digest food more normally.

3 – Reflux Medications: These drugs, which are not approved for use in children by the way (with one exception), diminish digestion by reducing acid in the stomach. Great for an initial reprieve from what may (or may not) be a painful reflux, but bad longer term. The more stomach acid is reduced, the less your child is able to digest food, and the more food will sit in the stomach and – you guessed it – reflux up to the throat. Many kids in my practice end up on highest allowable doses of these drugs, but still have feeding problems with weak appetites and texture aversions. Reflux medicines also exacerbate fungal infections in the digestive tract, creating even more dysbiosis and difficulty with feeding and eliminating. Solution: Unless your child needs “mercy” dosing of a reflux medicine to ease pain, talk to your doctor about weaning off of it. For more help with that process, check this blog and contact me for an appointment.

4 – Weak Iron and Zinc Status: These minerals have a lot to do with what we feel like putting in our mouths. Even adults with poor iron or zinc status will do weird things like hang around, sniff, or even lick gas pumps, chew on paperclips, or refuse to eat vegetables. If your child is mouthing objects beyond early toddlerhood, or insists on eating non food items into school age years, it’s time to straighten this out. It could help normalize eating “behavior”. Solution: Have your pediatrician run labs for ferritin, serum iron, transferrin, iron binding capacity, and serum zinc. These should be solidly in the middle of the lab range – not near either end. If these labs come back looking a little weak, get guidance on supplementing these minerals. Iron and zinc won’t be well absorbed, by the way, if your child takes a reflux medicine – so this is another reason to get off that stuff. It reduces absorption of minerals and B vitamins. Not what your child’s developing brain needs.

5 – Opiates: Wow, what WHAT? Yes, your kid might just be a little high on opiates all day long. Common signs: Do they wake up from 1 to 3 AM all silly or active? Are they constipated? Do they have a crazy voracious appetite and a big head (above 90th percentile)? Are they verbally delayed? Do they bang into stuff and never cry about it? Do they really, really seek proprioceptive input, to the point of endangering themselves? Are they hyper? Do they meltdown fiercely when hungry, or if you don’t hand over that favorite mac and cheese,  yogurt, or noodles and butter STAT? Addictive, opiate-like neuropeptides can form from wheat, dairy, and soy protein in a gut with certain digestive impairments. This will make a child relentlessly, extremely, fiercely picky for wheat and dairy food (maybe a little soy too). Yes, food proteins can be misappropriated into compounds that look like opiates to the brain. This happens when digestion is weak and the gut is too permissive; that is, the intestinal wall lets bigger-than-it-should molecules across into circulation, something a healthy intestine won’t do. These opiate-like compounds have various names: Dietary peptides, polypeptides, casomorphin, gliadorphin, or exogenous opiates. Urine screening is available to identify these. These will cause a lot of problems, including stunted language development, social delay, some crazy, even violent or aggressive behavior – and, uber picky eating. Feeding clinic will go nowhere if your child is swimming in opiate like peptides from milk, yogurt, Pediasure, bread, pudding, crackers – any wheat or dairy food. It’s all your child will want to eat, and anything that looks or feels different will be a non-starter. Solution: Start with my e book on milk addicted kids. If you need help getting your child out of this hole, set up an appointment to get started. Your child may need a strict gluten, casein/dairy and soy free diet (the prime opiate offender foods).

Get your kids clear of these five physiological problems and you may be amazed at how swiftly they graduate out of feeding clinic. Ignore any one of them and it is going to be a longer haul. Check out my quick video recap, click here. Thank you for stopping by.