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When Do Kids Need Iron?

When Do Kids Need Iron?

How can you tell if your child needs extra iron? How do you supplement? Is it safe? Is it necessary? Can you do it with just food?

I’m asked these questions a lot, and I’m often in the position of suggesting iron screening, for kids who show signs of anemia, pre-anemia, or marginal iron status. Iron repeatedly pops up as problematic for many US children, based on government survey data collection that began in the early 1960s. Anywhere from 5% to 15% of kids in the US are in poor iron status. Being overweight appears to double the risk for kids, of having low iron. There are racial and ethnic disparities too, with non-white children possibly more likely to have low iron status.

How iron works in the body is a complex topic. It has many jobs besides helping blood carry oxygen to tissues. Weak iron status will trigger cognitive and behavior problems in children. It’s one of the first nutrition pieces to screen when kids have hyperactivity and inattention. Low iron can have lasting, possibly irreversible, negative impacts on IQ, if it has been present long enough. Interestingly, iron is especially key for math learning – so if math tasks stand out as problematic for your child, consider iron screening. Iron is critical for normal immune function and neurotransmitter balance too. So if depression, anxiety, or insomnia are in the mix, once again, iron may be part of the problem.

As necessary as iron is, it is also toxic. Our bodies have ingenious ways to shuttle iron around safely, so it doesn’t damage tissues or overload pathways where it isn’t needed. Too much of it can be lethal for anyone – not just children, though children are more vulnerable more quickly, by virtue of their smaller body weight. So, if you are supplementing iron, do it with professional oversight, so you can be sure your child isn’t getting too much. If you are uncertain, ask your pediatrician for screening. This will require a blood test, but it is well worth the trouble, to safely correct iron status if a supplement is needed. Even if you learn that it is not needed, this is good information that can keep you safely replenishing your child with food. Mild to moderate iron deficiency may show no obvious signs or symptoms, and this is where a blood test can be useful. A thorough iron assessment includes these lab tests:

  • ferritin
  • transferrin
  • serum iron
  • total iron binding capacity
  • percent iron saturation
  • total unsaturated iron binding capacity
  • complete blood count
  • hemoglobin
  • hematocrit

Just checking hemoglobin (Hgb) and hematocrit (Hct), which can be checked with a quick finger-prick and single drop of blood, is no longer regarded as sufficient to assess iron status. Once those two tests drop below the reference range, it’s likely that low iron has been a problem already, for a long time. In other words, checking just Hgb and Hct is a case of too little, too late, when it comes to screening iron status. At a minimum, your doctor should include a ferritin level test in any iron screening. Though reference ranges drop as low as 6 or 10 nanograms per milliliter for ferritin, children function better when it is at 30 or 40. In my own practice, any child with a ferritin below 30 will receive nutrition support to improve iron status, if they exhibit any of the signs below. Depending on other findings, this may be from food, from herbs, or from iron pills – but in any case, all is carefully monitored.

shiners on child low iron

Signs of weak iron status include…

  • Dark circles under eyes
  • Pale countenance
  • Broken, restless sleep
  • Irritability, mood lability
  • Depression, anxiety
  • Frequent infections, colds, illnesses
  • Inattention, hyperactivity

At this point, your child may have pre-anemia. The body is not yet fully depleted for iron, but ferritin may be dwindling toward the 20s or teens. Ferritin is a storage molecule for iron. Once it is low, there is little cushion for the body to sustain demands for iron – things like infections, colds, busy learning activities, or normal sleep rhythms, not to mention physical exertion. You can consider foods that are iron rich as well as gentle herbal supplements (be sure to ask your doctor for guidance) or iron supplements, in the 5-10 mg range daily.

Once a child is anemic, things change. At this point, the body is truly depleted for iron. Your child may exhibit:

  • breathlessness, easily fatigued
  • sleepy during the day
  • unable to complete tasks
  • physical weakness
  • dizziness
  • cold hands and feet
  • irregular heart beat
  • anxiety, apprehension
  • chest pain
  • veins visible through pale skin
  • nose bleeds
  • heavier, more painful menses

Blood work guides the replenishment strategy. Your child may need high dose iron, at levels in this table below, for some time:
Iron dosing guidelines for kids

Once the body is anemic, iron can take months to restore. Your doctor may (should) repeat blood work after a few weeks on an iron supplement, to monitor progress. Don’t use doses this high on your own – get guidance.

Typically, pediatricians prescribe a form of iron called ferrous sulfate. Many kids don’t tolerate this well. Ferrous sulfate can cause stomachaches, constipation, headaches, backaches, and poor appetite. Some children also have dramatic spikes in disruptive behaviors when they take the iron they need. Other more tolerable forms are available, such as ferrous bis-glycinate, food based supplements, or iron rich herbal liquids. Liquids, chewables, and tablets are available.

Liquid Herbal Iron

Keep up iron rich foods of course too – eggs, lentils, pumpkin seeds, red meats, dark leafy greens, sesame tahini, chick peas, hummus, Brussels sprouts, raisins, dried peaches, potatoes with skin on, arugula, sunflower seeds or sunflower butter – if your child doesn’t like these foods, you may have some work to do correcting gut microflora. Doing so usually broadens appetite.

If your child reacts badly to an iron supplement, especially with behavior spikes, this is another indication that you may need to balance gut microflora before supplementing. Microbes love iron, and giving it orally in high doses can essentially “fertilize” these microbes in the gut or body. This can manifest behaviorally. Investigate if there are active gut infections for Candida, Klebsiella, or other disruptive species. Clear them out with medications or herbs, and proceed with iron restoration from there. This can work best in some cases.

Another caveat is chronic inflammatory conditions. Inflammation in the body can shift iron findings on lab tests. Kids with asthma, rheumatoid arthritis, cancer, chronic illness, Crohns disease, or allergies may show a shift on blood work that makes iron status look weaker. Serum iron may be low while iron stores (ferritin) are high. If your child has a chronic condition and you are concerned about anemia, ask your doctor to refer you to a specialist who can help, as this may be beyond the scope of practice for your pediatrician.

Iron is a deal breaker nutrient – like any other! Nutrients are nutrients because research has shown them to be essential. Without them or with weakened status for any one of them, we falter – and kids are especially vulnerable. Balancing iron status can change your kid’s life. It may keep them off psychiatric medicine, and will restore their abilities for learning and playing. Check into it!

Lentil soup is a good iron resource

Lentil soup is a good iron resource.

How To Get Kids Off Miralax

How To Get Kids Off Miralax

Miralax is one of the most commonly prescribed drugs for infants, toddlers and kids. It isn’t FDA approved for them. It contains ingredients found in anti-freeze. Concerns for its toxicity have mounted (as they should – one child in my practice slipped into a coma during an in-patient, closely monitored procedure to give high doses of the laxative ingredient in Miralax to clear a fecal impaction). The label states it is only to be used by adults for up to seven days – but children have entered my practice who have been on it, with their gastroenterologists’ blessing, for years – which is not unusual. And when I meet these kids, they are still constipated, still unable to move bowels without drugs or suppositories, still picky eaters, and they don’t feel good. Their parents want them off Miralax, and so do I. Having messy, uncomfortable “applesauce” stools every day – or none – is not healthy.

The Truth About Miralax Use

The truth is, besides having potent toxicity for at least some children, this drug does nothing to treat causes of constipation. Like many drugs, it is a bandaid approach. What it does do is turn stool into mush, by pulling more water into the intestine. Children can go from being impacted with hard dry feces (very uncomfortable, and encourages toxins from stool or disruptive microbes to leach back into circulation), to expelling some mushy stool regularly. But, they can still be left with impacted, sticky fecal matter, despite using more, more, and more Miralax.

A common picture that I’ve encountered in my practice for kids on this drug is “overflow diarrhea” – that is, blow outs of loose stool every few days, with or without firm, hard, or dry plugs of stool. This overflow, which seeps around the impacted matter, causes staining in pants that kids (or teens) can’t control. For toddlers, it can explode up the child’s back and and down to ankles. Many moms have described to me the daily chore of stripping kids down, bathing them, and getting fresh clothing because this pattern covers their toddlers or babies in stool.  Older kids experience embarrassing stool accidents with this pattern. Needless to day, this is exasperating and concerning for parents – and miserable for kids. Regardless, it’s common for pediatricians to use Miralax indefinitely anyway: In 2013, Miralax was the fourth most popular drug in the “digestive” category, with nearly $180 million of it sold!

There are many other solutions. They are non-toxic, safe, and more effective. My top three interventions for constipation are…

Mycelial form of Candida

Mycelial form of Candida – Why you don’t want to go there

1 – Assess and clear fungal infections in the gut.

Prevailing thought in gastroenterology today dictates that nobody gets fungal infections, unless they are immune suppressed. It’s rare for GI docs to regard fungal infections in the gut as a problem. Your pediatrician usually won’t either. Their belief is that fungal microbes (aka yeast, Candida, mold) are normal residents in human intestinal micro-biomes. True enough – if there is little to no fungal growth there. A lot of fungal microbial growth is not normal. Without testing stool specifically for fungal culture, there is no way to know what is growing in there, or how much of it. Healthy kids can have fungal infections in the gut. Antibiotics, C-section delivery, prior thrush, using reflux medicine or use of some infant formulas can trigger fungal overgrowth in a baby or child’s gut.

Most GI doctors do not screen for this, but many functional medicine labs offer this test. I use it often in my practice. Why? Because fungal overgrowth in the gut can be quite constipating. A simple treatment with anti-fungal medicine can fix it. Drugs like Diflucan, Nystatin, or Sporanox do this. There are not many anti-fungal drugs out there, which is one reason why doctors are hesitant to use them unless they really have to – they don’t want resistance to develop to these drugs. But if a child is so constipated that they’ve spent years unable to eliminate normally or painlessly, or they can’t eat well, grow, or thrive, then it’s time to pull out those big guns (IMO!).

If your baby has had thrush – that is, a white coated tongue, or a diaper rash with white patches in stool – an anti-fungal medication may be offered, because thrush is a kind of fungal infection. But fungal load can persist deep in the GI tract, which, don’t forget, is several feet long. There is plenty of space between mouth and anus for fungal microbes to thrive. Just because the white coating on the tongue is gone, and the diaper rash too, does not mean the fungal infection is all gone. A lengthier course of medication can clear the problem, if it is lingering in colon or intestine.

Herbs can help keep fungal infections cleared out too. Common tools include tinctures or capsules of oregano, thyme, grapefruit seed extract, goldenseal, berberine, uva ursi, caprylic acid, black walnut, garlic, undecylenic acid, and many others. I often support my patients’ gut micro-biomes with herbal tools, so contact me if you need this help.

This product blends several herbs to help clear fungal infections in gut

This product blends several herbs to help clear fungal infections in gut

For entrenched fungal infections, I have not found probiotics alone to be effective. In fact, a popular probiotic used for intestinal fungal infections called Saccharomyces boulardii (“Sac B” for short) is problematic if used incorrectly and may worsen constipation. A more aggressive, multi-pronged approach is more successful: Direct clearing of the fungal infection with an herbal or prescription agent; different food; and, lastly, the right probiotic.

Strangely, while Miralax is not FDA approved for youngsters, anti-fungal medicines like Diflucan and Nystatin are approved for use in infants. They are safer. They can do a good job of clearing constipation from fungal infections, so explore this with your doctor if your child has been constipated for a long time. Don’t be daunted if you are dismissed. Find an integrative health practitioner who will help, and talk to me about non-prescription supports.

2 – Lose the reflux medicine!

Fungal infections worsen reflux, and reflux medicines worsen fungal infections. Click here for more on why you don’t want to leave your child on reflux medicine for very long. Like Miralax, reflux medicines are widely prescribed for babies and kids – some say over prescribed – but are not approved for use in those age groups. There are no proton pump inhibitors (reflux medicines) approved for use in infants age one year or younger. There is only one approved for use in children under age eleven years. Still, I have encountered countless infants and toddlers given reflux medicines only approved for adults, and left on them, for over a year or even two. This will worsen constipation, since it worsens fungal infections, and lowers digestive function overall. Using reflux medicine long term also diminishes uptake of many nutrients, especially minerals. Two children in my practice who used reflux medicines for over a year suffered fractures later on, and others have experienced stunting and delayed bone age. They were not absorbing minerals normally, and could not mineralize or grow bone as expected.

Talk to your doctor about weaning off reflux medicine if your child has used it for more than two months. There are many ways to improve digestion and diminish reflux without drugs. This is also one of my specialties in practice, so contact me if you need help. Changes in foods and use of herbs can gently enhance your child’s digestion while you wean off a reflux medicine. Correcting the gut micro-biome will help as well. Do this with guidance for better, faster results.

3 – Use Magnesium.

This one is so simple. Magnesium is an easy way to pull water into the gut without toxic effects from peculiar ingredients in products like Miralax (dyes, gluten, polyethylene glycol). Magnesium oxide is a stronger laxative than magnesium citrate; magnesium citrate is stronger than magnesium glycinate. There are other forms of magnesium besides these three, and depending on your child’s presentation, there is probably a magnesium option that can get him or her off Miralax. A very effective product, widely available, called Mag O7 is an ozonated form of magnesium that has worked beautifully for some of the most constipated children in my practice. Use this with guidance; the label instructions are intended for adults, and this dosing is too high for most children.

How much? Magnesium is calming, which is great, but too much is sedating and may slow heart rate. So this must be used with guidance, especially for infants or young toddlers. I choose which product and what dose, based on each child’s case. There are liquids, powders, and capsules of various magnesium products. One of the most popular is Natural Calm, available on many supermarket store shelves. A teaspoon gives 350 milligrams of magnesium citrate. This is a large dose for an infant, but may be perfect for a school age child. More than two teaspoons daily is not likely to be necessary and may be too sedating for your child. If you have any questions about using these products, especially if your child takes other medications, ask your pharmacist or pediatrician.

These three ideas are only the beginning. From foods to herbs to drug-free options, there are many ways to clear constipation that are not only non-toxic, but more effective than Miralax – and they create better overall health by replenishing and balancing the cause of constipation, rather than giving it a toxic bandaid.

Click on the graph below, to see the absolutely mind boggling amounts of money spent on “digestive” drugs. These data are only for the year 2103! Which of these has your child used, and which would you like to replace with non-toxic, healthy options? It’s possible. Need help getting your child off of Miralax for constipation? Contact me and let’s get started!


Digestive Drug Sales 2013

Protein Powders – Which Ones For Kids?

Protein Powders – Which Ones For Kids?

Protein supplement powders line the shelves now just about anywhere groceries are sold – from Trader Joe’s and Whole Foods to conventional supermarket chains. The choices on-line are even more complex and infinitely varied. Can they work for your kids? Do your kids need them? Are they safe? Yes, maybe, and yes. Here’s the scoop on knowing which ones to use, how, and when.

Do they work? Depends on what you mean by “work”. They do work if your kid needs the support, if your kid uses them consistently (daily), and if you match your kid’s nutrition needs to what’s in the product you’re using. They can help your child grow and gain better, behave and function better, and fight infection better.

But…they don’t work if you choose one your child just won’t eat. Another fail is to choose the wrong protein for your child’s nutritional needs. Ever try a soy or rice protein supplement powder, only to be disappointed? It’s common for these proteins to cause more trouble for kids who don’t tolerate them well. Protein supplements don’t work if you’re using a source that worsens an undiagnosed allergy or sensitivity. This is something I see so often in practice, it’s alarming: Kids will be placed on milk and soy based formulas like Pediasure, Boost, Pepdite, or Ensure when no on screened for allergies first! This can worsen growth, feeding, and progress, not help it. Knowing what type of protein (soy? dairy? egg? hemp? pea? amino acids? meats?) your child needs is important.

They also don’t work if your child doesn’t need the supplement; they probably won’t add any value in that case, and aren’t worth the extra hassle or money, unless your kids just like the stuff and it gives them a fun option to have a daily smoothie boost. Kids who eat a varied diet with plenty of protein sources probably don’t need a supplement. “Varied” means eating more than just one kind of protein. It means your child gets protein from different foods every day, like eggs, green beans, peas, other legumes, or beans …to meats, poultry, nuts, seeds, or grains like quinoa. In contrast, kids who only eat dairy protein all day long (yogurt, milk, cheese, mac and cheese, pizza) are usually not getting an adequate diet. Even when they eat enough total protein daily, if it’s from just one type of food, they can easily drop nutrition in other areas and will suffer deficits as a result.

How much is enough? School age kids who are healthy and growing normally need a bit more than half their weight daily, in grams of protein. So, a child weighing 70 pounds needs at least 40-50 grams of high value protein every day, spread through out the day. Growth failure, allergies, frequent illness, inflammatory conditions change protein needs. Getting professional nutrition guidance will assure your child gets the best food for his or her best health and ability potential. Toddlers and infants have different needs; don’t use off the shelf protein supplements for kids under three, unless you have a knowledgeable pediatric nutritionist or specialist guiding you on what’s best.

When do kids need protein supplements? So often, this can can really help a child out. Several circumstances can drop a child’s protein intake so that they falter, grow weakly, get sick too often, or just can’t function to potential. Functioning to potential means they can grow as expected (they don’t drop more than fifteen percentile points on a growth chart for weight or height). It also means they can do important things like sleep well, play energetically, behave in age appropriate ways, pay attention and focus appropriately for age, handily fight off usual infections, have few infections, and have fun. If your kid struggles in any of these areas more than you think is their “normal”, or if you just have a hunch something is off kilter, the right protein support may make a huge difference. Check this list of reasons to consider supplemental protein powders. Does your toddler, child, or teen fit any of these?

protein powder scoops

…Refuses protein-rich foods due to texture aversions (gags or vomits or spits out meats, eggs, ground meats, mixed dishes like chili or stews with meats)

…Has a picky appetite, tends to eat only dairy for protein, or only wheat (bagels, pasta, bread, pizza, crackers)

…Has food allergies, sensitivities, or any reactions that limit access to proteins (can’t eat dairy, egg, nuts, gluten, etc)

…Has a history of growth failure or slow growth pattern, is shorter than expected, or has been called “just small” by your doctors

…Has anxiety, poor sleep, night terrors, frequent waking, mood disorders, or conduct disorders

…Lost a school placement due to disruptive behavior

…Gets colds, bugs, sniffy nose often, and takes longer than siblings or friends to shake it off

…Has hair that looks thin or dull, or nails that crack and peel easily

…Cuts seem to heal more slowly than usual

The right protein support can shift all of these problems, sometimes in itself. Other cases may need total nutrition overhaul (such as kids who have low protein, poor total intake, and are deep into an oppositional, aggressive, or ADHD pattern). But starting with strong protein can get your child feeling better. Here’s some ideas.

Whey Protein Powders – About 20% of the protein in cow’s milk is whey, with 80% is casein. You’ve probably seen  those giant tubs of whey on store shelves, with muscles all over the label, to appeal to body builders. Skip those. They usually have other ingredients your child doesn’t need (especially sugar, or minerals and vitamins at excessive potencies). You can buy plain, organic, unsweetened whey protein powder (like this) and mix it with cold or warm foods, or even add it to baking recipes. It blends well in smoothies and adds a pleasant fluffy texture. Whey protein – with its good amino acid profile and immunoglobulins – has strong evidence for helping muscle mass and immune function. Babies and kids who don’t do well with casein may do fine with whey, but not always. Blood tests can discern this, when elimination diets are too cumbersome or time consuming to work through; I use both IgG and IgE testing to whey and casein in my practice.

Whey protein is where nature puts the immune power pack, when it comes to milk. In human milk, the ratio is the nearly opposite of cow’s milk: We make milk with only about 40% casein, but 60% whey. Whey has lactalbumin, lactoglobulin, lactoferrin, and other immunoglobulins that fight infection and build immune strength. These cysteine-rich proteins are also excellent glutathione precursors. Glutathione is our go-to molecule to remove toxins, reduce inflammation, and support vigorous immunity. Buying whey that is not denatured ensures that these delicate but potent proteins stay viable. Denatured proteins are proteins that are heated or processed so much, they lose their original shape – and, their original actions as immune modulators. They may also become more allergenic, since their shapes differ from what the body may be able to digest. For my patients, I like Well Wisdom whey protein from grass fed, non-GMO milk.

Soy Protein Powders – Whether it’s in a power bar, a powder, infant formula, or a protein boosted juice drink, I’m not a fan. Soy in the US is overwhelmingly genetically modified. GMO foods are not allowed for human consumption in most the developed world. They are under scrutiny for causing more allergy and many other ill health effects. Soy crops may also concentrate glyphosate, the pesticide recently dubbed “probably” carcinogenic by the World Health Organization.

There are so many reasons why I don’t like concentrated processed GMO soy protein, especially for babies, who are busy developing a healthy gut biome in their first years (glyphosate kills healthy gut bacteria in humans). Healthy gut flora are critical for preventing allergy, asthma, and other vulnerabilities later in childhood or even later in life. Eating food crops engineered to produce their own glyphosate (which is what GMO food crops do) is perhaps one of the most devastating thing we can do to a baby human gut!

More reasons I don’t like soy protein supplements: Unfermented, highly processed, and concentrated soy protein is hard to digest, can bind other nutrients, disrupts thyroid and estrogen function, and may trigger allergy just as often as casein from cow’s milk. I don’t recommend it as  daily protein for kids. Eaten from an organic source, in small amounts, in its natural state or fermented, such as in tempeh, miso, shoyu, tamari, or natto – this is fine, but your child will need other proteins. Tofu and edamame are not fermented and I also do not suggest using these as the bulk of daily protein for children. I know opinions vary; this is my take, after nearly twenty years in practice with infants and children.

Rice Protein Sprouted PowderRice Protein Powders – Rice lacks lysine, an essential amino acid. That means that by itself, rice is not a good protein source (because humans must eat lysine; we can’t make it ourselves), so most manufacturers add lysine and possibly other amino acids to beef it up. Even rice protein powders that say they are “concentrated” or raw and sprouted can’t match the amino acid profile of animal proteins like whey, meat, or eggs. Rice protein still must to be augmented with some amino acids to work, especially for kids needing a strong protein boost. Besides this drawback, rice protein powders in my experience can feel gritty or grainy, have a strong taste (especially brown rice source), and are often rejected by kids with oral texture issues. Workable if your child is eating some other sources of complete protein, if your or if child just likes the taste of a rice protein product. Best rice option… find an organic sprouted source – here’s a few rice protein product reviews to consider. Or, buy a rice protein that is combined with pea protein, for a more complete, better tasting protein powder.

Pea Protein – On the scene more recently, this may be more palatable than rice protein powders for texture (not gritty or sandy) and for taste (more invisible to lightly sweet). It’s a more complete protein (with lysine and arginine amino acids). Like any plant protein, it has no immune modulators in it as whey does. But for some kids, it may be more digestible than rice protein, and can help get minerals like calcium into bones thanks to its lysine content. It also offers a bit of iron. Down side: Some kids who are soy-sensitive may not tolerate concentrated pea protein very well, as these plants are similar – if your child has loose stools on a pea protein supplement, this can mean an allergy or sensitivity is brewing to soy, pea, or other legumes. Blood test for ELISA IgG can find out.

Hemp Protein – Helpful for kids who can’t manage other proteins due to sensitivity or allergy, but there are mixed reviews on whether it is enough of a boost for kids needing strong support. How the hemp is grown and processed affects its amino acid profile; some hemp protein products claim to have all amino acids essential to humans in them, some don’t. Hemp is rich for amino’s that help us make globulins, similar to proteins we make for immune function; other peptides in it may have beneficial antioxidant effects. Either way, two heaping tablespoons may only add 5-8 grams of protein, which is less than most other  protein supplements. Hemp has more essential fats and more fiber than other protein powders, which is good and bad: Good for the nutrients (hens fed hemp seeds lay eggs with more healthy fats in them), but maybe too much texture for picky eaters who are used to smooth. Hemp protein powder is also dark green, so it won’t hide well in concoctions for kids who are averse to fruits or vegetables in their smoothies. There is a nice profile of minerals like magnesium and zinc in hemp protein powder, and it’s more digestible than soy.  If your child is good with the texture of nuts and seeds, but has allergy to these, try whole hemp seeds in snacks instead. They’re tiny like sesame seeds, but soft and chewy, and can work in smoothies, granola, or sprinkled on salads. They can have a strong taste.

BIO_Superfoods_SpirulinaSpirulina and Blue Green Algae – Yes, it was used by the Aztecs centuries ago, when they harvested and dried spirulina from lakes in a then-pristine environment. How about now? It is a complete protein, also rich in vitamins and minerals, but falls somewhere between egg and lower value plant proteins for its amino acid profile. Because of this, more if it has to be eaten to get enough for the tissue re-build young kids need when struggling with protein intake and absorption (same problem as hemp protein on that score); this can trigger loose stools. Bonuses: Spirulina has shown some capacity to reduce histamine (less allergy); it has carotenoids in it that can promote eye health; and other phytochemicals in it may have protective effects against certain cancers. Many other health claims are out there for it, but these aren’t well studied in people. It’s decidedly green, and will add that color to anything you stir it into, which can once again really throw kids sensitized to texture or color changes in food. Whether or not blue green algae protein powder can be had today minus the pollutants and toxins everywhere in our environment (heavy metals, pesticides) is up to the manufacturer to monitor and declare (don’t wait for the FDA to do that for you!). Not to be confused with Spirutein, which is a soy protein concentrate mixed with some spirulina from algae; some Spirutein offerings also blend in pea and rice.

Collagen – This is one of my new favorites. Collagen protein from “clean” sources (organic, non-GMO, grass fed) is fine enough to easily dissolve even in water or tea. Brands like BulletProof and Zint Hydrolysate are workable in smoothies, soft foods, or juices without adding grit or any strong flavor.

Free Amino Acids – I’ve said “amino” a lot in this post. Amino acids are the building blocks of protein molecules. Nature created about 22 of these amino building blocks, and we must eat a certain 8-11 of these every day from foods to survive, because we can’t make them ourselves. So, proteins are compared based on their amino acid profiles. Any protein will usually have all of the amino acids present in some amount. The question is, how much of each one? Proteins like egg are high in all of the essential amino’s that we have to eat. No plant proteins are, unless they are augmented or processed to boost their profiles, or unless you eat a lot of that one protein (as would be true for eating hemp or blue green algae proteins). Eating plant proteins with other plant proteins that fill in the missing amino’s for each other is how vegetarians and vegans eat well, and this is also how some of the protein supplement products out there are boosted – they’re paired up.

Thorne Amino-Complex-Lemon-webSo what about eating free amino acids, instead of protein that must be broken down? You can do that too, and this can be a very good tool for kids with injured, inflamed, or delicate guts. Multiple food allergy children can benefit here too. I use free amino acid supplements often for these children. The FDA regulates these as “medical foods”, and you can buy them over the counter, as in a product like Thorne Amino Plex, or in specialized formulas, like Neocate, Elecare, or just as pharmaceutical grade amino acid powder. I have used all of the above with impressive results in infants, toddlers, and kids – with a total, integrated nutrition are plan in place. In some cases, free amino acids can be prescribed and covered on insurance.

Take away? Kids who have anything on my bullet list above need nutrition support. Is a protein powder going to help? Maybe. Need to talk? Schedule it now, I look forward to hearing from you!

Supplements For Kids With Autism: Who Do You Believe?

Supplements For Kids With Autism: Who Do You Believe?

Earlier this month, Autism Speaks touted a study claiming that “few children with autism need most of the micronutrients they are commonly given as supplements”. Their take-away was a headline shouting that supplements “lead to nutrient imbalances”. We are to be impressed because, per their math, this was “the largest study of its kind.”

In this case, size doesn’t matter.

So much went wrong here that I’m not sure where to begin. So I’ll start by saying this is one study you don’t need to believe. Here’s why:

The authors didn’t study what they concluded. Its abstract’s opening statement says: “Little is known about the effect on dietary adequacy of supplements given to children with autism spectrum disorder.”

For now, bear with me, just nevermind that this statement isn’t quite true …there have been thousands of studies, including clinical data and case reports, describing supplements in children with autism. In fact, it looks like there are some 27,500 of them, glancing at Google Scholar.

Okay nevermind. Back to the study. Its concluding statement is…

“Few children with autism (ASD) need most of the micronutrients they are commonly given as supplements.”


The authors set out to examine the “effect” of supplements on “dietary adequacy”. Not the effect of supplements on kids. They also didn’t study what these kids need… So how did they conclude they don’t need supplements that they’re given?

They didn’t evaluate the kids. They didn’t evaluate whether they needed supplements, or if supplements helped them. In fact, they didn’t assess the children’s nutritional needs at all. There is no lab data, no blood work, nothing at all to define what these kids may have actually needed for supplementation. The data set was tabulations on food and supplements the kids ate. After some sparkly statistical gyrations, this data set was compared to government Daily Reference Intakes for healthy kids. That’s it.

The authors didn’t mention that kids with autism might have different nutritional needs than their peers (as you can find perusing those 27,500 studies linked to earlier). Instead, the authors looked at “dietary adequacy”. How do they leap from here to the conclusion that “most” kids with autism don’t need supplements they’re receiving ?

In academic publishing, leaps of faith like this are normally flagged by editorial boards and hand-picked peer-reviewers. But many practicing dietitians and licensed nutritionists (myself included) are concerned that the Journal of the Academy of Nutrition and Dietetics (AND) is too close to industry to be impartial. AND’s stated mission is “improving the nation’s health and advancing the profession of dietetics through research, education and advocacy”. But some nearly 14,000 of their own dietitian members have splintered off to form Dietitians For Professional Integrity –  a group demanding that AND out itself for all its corporate sponsorship, and redirect its educational resources for dietitians. AND is supported generously by Coca Cola, Monsanto, ConAgra, PepsiCo, McDonalds, General Mills, the Corn Refiners Association (high fructose corn syrup, anyone? Soda, candy, juice?) and The Dairy Council, to name a few heavy hitters.

"This is 'cheese' in same way AND is an 'Academy'"

“This is ‘cheese’ in same way AND is an ‘Academy'”

The study was published in a journal criticized for industry bias. Remember Kraft Singles earlier this year? AND accepted money to put their “Kids Eat Right” seal of approval on this product, which dropped a well-deserved  avalanche of unforgiving satire in their laps. No surprise – AND has long enjoyed sponsorship from global corporations who sell processed, over-sweet, GMO, pesticide-laden, and dairy-rich foods to kids – exactly the kinds of foods that most any kid shouldn’t be eating much of, let alone kids with autism. AND has tiptoed around the autism issue for nearly two decades, skirting training for dietitians in the use of things like supplements, gluten or casein free diets, organic foods, grain free diets, or biomedical tools for kids with autism. When it comes to spear-heading nutrition interventions for children with autism, AND has been a virtual no-show; in fact, you’d be hard pressed to pick an academic nutrition journal that is more tepid, hostile even, that this one, on cutting edge autism-nutrition research.

Shoot, I digress again. Let’s go back to the study. We care about the kids, and whether they might benefit from supplementation, right? We don’t care about oblique semantics on “dietary adequacy”. Well, nevermind. Let’s roll with this, and see how the authors define “dietary adequacy” for these children.

Oh wait – they didn’t do that either. Instead of assessing the kids to see if they were in normal nutrition status (as many children with autism are not, if you actually do the work to find out), these authors cherry-pick one study from Pediatrics to bolster their idea that (a) kids with autism eat like any other kids do and (b) they therefore have no special nutrition needs.  And, this study comes from the same lead authors – they cited their own previous study. Based on that, they continued with the house-of-cards strategy that it must be okay to conclude that these kids “don’t need most the supplements” they’re given.

But, if you read the Pediatrics study closely, here’s the most perplexing part: The authors found that with autism do eat more poorly compared to typical peers, especially at ages 4-8 years. In fact, it found that ASD kids ate less vitamins A and C, less zinc, and less food than kids without autism. Kids with autism also had growth problems more often too – either underweight or overweight. Even when their own data shows a problem, the authors brushed it aside. Why the authors white-washed that out of their conclusions is a mystery. But one thing is clear: Citing their own prior study as proof that all these kids, autism or no, generally have the same eating patterns is another fail. Onward they leap to the next misstep: They assume that it’s okay to use Dietary Reference Intakes (DRIs) as a definition of “adequate” for children with autism.

As any nutrition professional knows, DRIs don’t apply to those with chronic health conditions. They are based on healthy people, and intended for use as a guideline only, for healthy people. Here is a quote from the preface of the DRI book for thiamine, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline (that’s the B vitamin group, and yes, there is a stand-alone tome just for those… it’s over 500 pages long):

“Evidence concerning the use of these nutrients for the amelioration of a disease or disability was not considered because that was beyond the project’s scope of work.”

So there you have it – The authors used an invalid “control”. They self-declared the DRIs a valid baseline or control for this group of kids, when it may not have been. According to the DRIs, you can’t use DRIs for kids with chronic conditions or disabilities as a definition of “adequate”. It’s not scientifically valid. And you can’t use a set of numbers as a control group for children; you need other children.

Many things can change what is “adequate” for kids with autism. Besides quirky food intakes, an inability to efficiently excrete toxic metals, or a simple gene mutation or two for MTHFR or vitamin D receptors, nutrient needs can be quite different for those with autism. Epigenetics, the study of how environmental factors like nutrition or toxicity direct gene expression, is a promising treatment niche for children with autism – but you would never know it reading the latest from Autism Speaks.

What is adequate for these kids? To know that, you must do much more than compare what supplements they eat to DRIs, which is all that this study did. It found supplements given to kids with autism exceed DRI levels, while others remain below DRI levels. These findings don’t tell us much of anything at all, except that children with autism should have professional medical nutrition support, so they can be safely and effectively supported with supplements if needed. It’s a shame that the authors and Autism Speaks chose a headline to shift parents away from exploring this tool, which may be beneficial when used correctly. Each child with an autism diagnosis needs individualized nutrition care from trained, experienced professionals – and contrary to what this article suggests, this help is not likely to come from dietitians who don’t stray from the AND box. Your provider should have years of experience going the extra mile on their own to train in subjects like biomedical interventions, toxicity, gut health, epigenetics and supplementation with autism diagnosis. It’s tough to go this alone as a parent, as it’s arguably the most complex intervention that a child with autism may get. If your care team isn’t savvy on this piece, check out my books, blog, or resources on the web like TACA or MAPS for more support.


Are Thrush and Yeast Infections Pediatrics’ Biggest Fail?

Are Thrush and Yeast Infections Pediatrics’ Biggest Fail?

Can a baby have a fungal infection? Yes – and undiagnosed, untreated fungal (yeast, thrush) infections could be one of one biggest failures of pediatrics today. How could this be?

I have often seen untreated thrush/fungal/yeast infections in babies, toddlers, and kids persist, then shift, into deeper, entrenched problems. Then the prescription drug parade ensues, usually in this order, with only limited or modest success: Prilosec (or other reflux medicine); Pediasure; Miralax; Ritalin, Concerta, or other stimulant, followed by something for anxiety or depression, like Straterra, Zoloft or Seroquel. Is this health care, or drug dependency? And are the kids feeling great, or lousy?

Most children who come to me for nutrition intervention only get to me as a last resort. They’ve been to gastroenterologists, neurologists, psychiatrists, feeding therapists, occupational therapists, behavior therapists, speech therapists. The last thing their parents want to do is change up the food in the house – especially when specialists don’t help them do that, and they tell parents it won’t do any good anyway (as most of them have told my patients). Too much work, right?

But eventually parents are at wits’ end. They have a picky child who eats poorly, grows weakly, or has reflux. Or they have an enthusiastic but still picky eater (read: stuffs food in mouth to choking) who loves starchy, sugary food like bread, chips, cheese crackers, candy, carbs, dairy junk (yogurt tubes or sugary milk substitutes). Their kids have big behavior problems: Tantrums well past toddler years. They can easily melt down, overstimulated, in public places, like restaurants, supermakets, or malls. They struggle at school, for being aggressive, combative, inattentive, or oppositional. All before they are five or six years old…. Uncle! Time to try that crazy nutrition stuff.

You’ve probably heard of Candida, or yeast infections, or thrush. And we’ve all heard a lot about gut biome, and how crucial it is for many aspects of health. This burgeoning area of research may not make the pharmaceutical industry very happy. Turns out that nearly any chronic condition – from Alzheimer’s, asthma, and autism to anxiety, depression, rheumatoid arthritis, and much more – may be treatable through improving the microflora (bacteria) in your gut.

How do you do that?

Easy. You change what you eat. You use the right probiotics, tailored to your stool testing or your history. You clear out nasty gut microbes that don’t help you, and there are many fabulous herbs that can do that. You do this as a lifestyle, not as a ten day course of a drug. And, your body begins to restore itself from the inside out. That is the “crazy nutrition stuff” in a nutshell – and it’s not what your pediatrician is primarily trained to offer.

Recent reports indicate that you can even improve conditions like these through a fecal transplant – using a healthy donor’s poo to reboot your own colon with microbes that know how to run a clean shop in there. Good gut bugs communicate intimately with the immune system, and help it “learn” – learn what is friend, what is foe, what to react to, what to ignore, what to kill and pull apart, what to leave alone.

The pharmaceutical industry only makes hay when they can sell a patented product (as in for example, hundreds of millions of dollars in a single year from just one vaccine). But they can’t get far with … your poo. That stuff is yours. It’s definitely not patentable. Pharma also can’t get far with food, which is not patentable either. If you eat better, they lose money. Food isn’t patentable unless it’s processed beyond recognition or engineered genetically by Monsanto (patenting everything you eat is their business model, which is why they really don’t want you to learn about how bad GMO foods are for your gut, or to even know they’re in your food – hence the labeling battles). Probiotics are naturally occurring organisms. Not patentable, because they simply already exist. But food, probiotics, and even someone else’s poo may be better for kids than many of the drugs they are routinely given.

I digress a little here, but to a point: These addled kids tend to have really disrupted gut biomes. And, they are very often full of yeast. This can be like thrush throughout the GI tract, whether or not it’s visible in the mouth. That means there is too much Candida, Saccharomyces or other fungal strains in charge of the gut biome – and hence, your child’s digestion, absorption, and eliminations.

We find this out with stool testing that looks beyond the basic horrible microbes your insurance company pays a gastroenterologist to check for. We look for beneficial species like Lactobacillus strains, Bifido strains, and others. We also screen for annoying microbes like Klebsiella or Citrobacter species that may well be usual enough to find in a human gut, but not to excess. They shouldn’t be in charge of the conversation in there, so to speak. And if a child is underweight or in weak nutrition status, these microbes can have a pervasive negative impact.

And, we find yeast. Lots of yeast.

This is how fungal infections make you sick

This is how untreated thrush can situate itself and make your child miserable

Now, here’s the thing. Fungal microbes are somewhat usual members of our micro biome. But, they are normally kept in check by a healthy immune system. Mostly, they only raise an eyebrow for your doctor if your child has (a) florid thrush, in which white fluffy fungal stuff is literally coming out both ends – mouth and anus; or, (b) very serious immune deficiency problems, like leukemia or AIDS or neutropenia. If a child has a fungal skin rash, usual practice is to give a topical anti fungal cream. Other than that, pediatricians and gastroenterologists are generally unconcerned about yeast overgrowth in the body, because they are trained to only manage it for immune suppressed people.

But thrush can indicate yeast is a player even after an oral medicine like gentamicin clears it from the mouth. It’s easy to find out. Besides checking stool cultures or stool DNA analysis for yeast, I may also request a urine microbial acid test that looks for the “trash” that yeast cells make. Finding loads of this trash in urine means that yeast is present somewhere in body, possibly to a degree that is disruptive for mood, behavior, stooling, appetite, or more. It may even mean that a child’s repeat urinary tract infections are from yeast, not bacteria – in which case, antibiotics will not only do no good but will actually worsen the infection.

You can look at yeast (or mold for that matter) in many other ways with other lab tests, but the bottom line is this: A lot of children seem to be walking around with a lot more fungal and mold microbes in them than is healthy. What does this do? Typical symptoms are:

– Constipation severe enough for kids to be Miralax or enema-dependent, or to have had hospitalizations to clear fecal impactions

– Bedwetting well into school age years or even later

– Aggressive, rageful, violent, or oppositional behavior severe and frequent enough to impede learning, socializing, or ordinary tasking; abates if favorite foods are given, flares when hungry

– Appetite rigid for sweets, starches, dairy foods, and wheat (pizza, bread, pasta, crackers, mac and cheese, cookies)

– Refusal of protein foods (meats, fish, eggs, legumes, nuts, nut butters)

– Extreme pickiness for textures; easily upset by mixed food textures; refusal of fresh foods especially vegetables

– Dependence on reflux medicines (fungal infections can cause reflux, and reflux medicines cause fungal infections!)

– Allergies or sensitivities to many foods (which may be undiagnosed as well)

– Chronic fatigue, frequent malaise, with intermittent hyperactive bursts

The incredibly simple thing is this: Clear these fungal loads out of a child’s gut or body, and you have a different child. Behavior, appetite, everything starts to improve. The constipation ends. Gradually, given the right food and the right tools, the gut will start to heal up too.

But we haven’t even talked about the real problem here. Candida albicans, one of the most common yeast microbes found in our intestines, can shape shift from its initial “bud” form to a more debilitating “mycelial” form (see the pictures above). In this case, it grows little threads called hyphae that penetrate the gut wall tissue. It uses these to suck in nutrients for itself. It literally sends out little fingers that puncture your gut wall, in order to anchor itself there, eat and grow more, and hide better from your immune system. Watch the video to see what I mean:

Once in this mode, yeast and thrush infections are harder to clear. They create “leaky gut”, which creates more food allergies, more food sensitivities, and more susceptibility to other infections – including yeast infections in other locations. Many children start life susceptible to this scenario from birth. How? By receiving antibiotics directly or indirectly through mom, by getting a hepatitis B shot (made from a yeast strain called Saccharomyces cerevisaie), by arriving via C-section (in which case they miss getting mom’s vaginal flora on the way out), or by getting formula instead of breast milk (which favors undesirable microbes over beneficial ones).

Given that we know all this, we can do better for our kids. Many drugs prescribed for children – from Ritalin to Reglan – may become unnecessary, if underlying Candida infections are cleared, better food is in the mix, and the gut biome gets to work as intended. This can be straightforward to manage with the right non-prescription tools. Click the appointment tab above if you’d like to work with me on strategies to clear problems caused by untreated thrush or yeast infections. I look forward to hearing from you!


Salt Cravings In Kids: What They Mean, Why They Matter

Salt Cravings In Kids: What They Mean, Why They Matter

Many parents come in asking me about salt cravings in their kids. Seen any of these moves? Kids who lick salt, shake salt heavily onto everything including into water or other drinks, drink pickle juice, love olives and pickles, snack only on salty chips or pretzels, prefer starchy salty food to real food, or will eat meat only if it’s cured (bacon, pepperoni, salami…) are showing that their cells may need something. What does this mean?

To the body, salt isn’t just sodium and chloride. “Salt” can mean other minerals too, like potassium, calcium, magnesium, iron, manganese, copper, and many others. In fact, using just sodium chloride (which is ordinary table salt, like Morton’s), may deplete other minerals, and cause you to crave more salt – when your body may need other minerals as well. And if you truly lack sodium (an essential mineral that we need every day) then you will crave it, to the point where your taste buds will be altered to “like” a lot more salt than usual.

Salt in the US is mostly eaten from processed foods – pasta, bread, baked goods, yogurt, cheese, soft drinks, fast food, microwaveable frozen meals, condiments, sauces, mac and cheese from a box, soup from a can – you name it, it has salt in it. Even without salting food, unless you are scratch cooking everything and controlling your seasonings, your kids are probably eating a lot of salt. Salt in processed foods is typically sodium chloride, and not the healthier blend of minerals found in natural sources like sea salt or Himalayan salt – either of which I recommend for your kitchen.

Salt cravings are a tip that your child’s body might need more minerals, or that some minerals, including sodium, are being depleted too quickly. Common causes of wasting minerals are anxiety, stress (physical exertion, like a soccer game; or emotional stress, like nightmares, homework, school problems, family tensions), illnesses or infections, night sweats, or fever.

If your child has a chronic inflammatory condition like asthma or food allergies, this too may induce a desire for salty foods – because when there is inflammation, the body releases more coritsol and other hormones from the adrenal glands. These hormones both rely on and regulate minerals, and influence everything from blood volume to urine output and stress response. Salt cravings can mean minerals are lacking or imbalanced, or that the adrenal glands are struggling to keep up. Cortisol is vital to our well being – but too much of it is draining, depleting, and immunosuppressive. Too little of it leaves us extremely fatigued, dizzy, or confused. Besides craving salty stuff, you might see these signs too:

– muscle cramping easily on exertion

– fatigue

– insomnia

– dizzy when changing position (sitting to standing)

– low mood

Making sure your kids get mineral-rich foods every day can help. Filling up on sugary or starchy processed food displaces mineral rich foods. It also takes a lot of mineral co-factors to digest and process sugar. Eat more mineral rich foods, and add a good mineral supplement if your child isn’t eating enough of those. Foods like homemade soup or bone broths, stews, vegetables, sea weeds, nuts and seeds (or their butters), greens, pork, eggs, scallops (if you can find them and are comfortable with eating them), and fresh herbs are great ways to add minerals every day. Think arugula, basil, thyme, mint, cilantro, red butter lettuce, chard, beet greens, or kale. All of these work fresh and raw in smoothies, seared or roasted with vegetables, or simmered in stews and broths. Even dried thyme will add notable amounts of iron, calcium, and manganese to food. Fruits are less of a go-to for minerals than vegetables, so if you’re doing fruit smoothies often, great – now add some greens!

Use a variety of culinary salts in your kitchen for more minerals in your food

Use a variety of culinary salts in your kitchen for more minerals in your food

For a supplement, you may need to add a multi-mineral for your child. Kids’ multivitamins often have either no minerals or only very low doses of just one or two minerals. Here’s an example: Kids need anywhere from 10 to 30 mg  or more zinc daily, depending on what they already eat and what their health conditions are. If your child uses a chewable multi and it has only 2 mg of zinc, get them eating nuts, seeds, pork, and other zinc-rich foods or add a multi-mineral option. Products with or without copper or iron are available, if your child needs to minimize those two minerals. Have a look at Klaire LDA Trace Mineral Complex or Vital Nutrients Multi-Mineral Citrate (without copper or iron) for starters. For a well rounded multivitamin that also has minerals, one of my top choices is Kirkman Thera Response. I use these for children and like that the capsules are small enough for even young kids to swallow in many cases. You can order any of these sold-to-provider-only products by logging in to the Emerson Ecologics website with access code MyNCFC and password 80303, or just call them at 1-800-654-4432. They will give you a 10% discount on anything you order, when using my log in information.

What about those adrenal glands? Salt cravings may mean these glands are drained and depleted. These are tiny thumb-sized glands that sit atop the kidneys – but they are your body’s main “shock absorbers” – and they work hard. They regulate just about everything in the body, directly or indirectly. They need an array of minerals to manage fluid balance and blood pressure. They also directly control stress responses, by manufacturing hormones like cortisol, epinephrine, norepinephrine, and aldosterone. Your adrenal glands rely on a steady flow of varied minerals, fats, and protein to build this stuff and make it all work.

Don’t skimp on healthy salt in your kids’ diets, but leave the processed sodium chloride foods behind. Add culinary sea salt or Himalayan salt to your meals and let your kids salt their food. If they continue to have big cravings, let’s talk – there may be underlying issues that need attention, so their adrenal glands can function better. And have a look at Chris Kresser’s great piece on why salt restriction is not a good thing.