COVID-19 is our moment to rethink infection, and to rethink health. It’s a big moment.
By now, you know that we’ve seen corona viruses before: Middle Eastern Respiratory Syndrome (MERS) in 2012. Sudden Acute Respiratory Syndrome (SARS) in 2002. In fact, corona viruses were first discovered in the 1960s and have long been understood to cause a “substantial” portion of upper respiratory infections in children (that is, common colds). Despite decades of scientific effort, we haven’t emerged from any of this with sure fire preventives, drug treatments, or vaccines.
COVID-19 has been wreaking havoc and defying experts worldwide. COVID-19 behaves so differently in different persons that Atlantic Monthly has called it “a disease of the immune system”. Robert Murphy MD, a professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University, was quoted in that piece to say this: “’There’s a big difference in how people handle this virus…It’s very unusual. None of this variability really fits with any other diseases we’re used to dealing with’…When doctors see this sort of variation in disease severity, ‘that’s not the virus; that’s the host.’”
Essentially, COVID-19 kills people best when their immune systems over-respond with uncontrolled cascades of inflammation. It appears to exploit whatever your weak link is, and destroy from there, whether it’s lung, kidney, gut, heart, or brain tissue. Apparently, this virus isn’t picky, but it sure is wiley. Not everybody’s immune system is doing this. As more are screened for exposure status, we are seeing death rate drop, to perhaps as low as half a percent. #COVID19 is looking like an infection that serves up a catastrophic clinical course, but only for a subset of vulnerable people.
One option is to take the cue from Dr Murphy quoted above. It’s time to figure out why that half percent gets hit so hard.Maybe the solution is not about the virus. Maybe it is about our immune systems, which vary widely in their status, functionality, and readiness, and in our own risk factors, which are virtually exponential in complexity when we consider genetics, nutrition, health habits, toxic exposures, stress, drug use (recreational and prescription), and more. All of these impact each other, creating potential synergies in any direction, when you toss COVID-19 into the mix.
Right now, our health care system is a reductionist one that silos health problems into discreet specialties. It doesn’t pay much attention to nutrition or food, or toxic exposures, in routine care. COVID-19 has laid bare what a catastrophic fail this is, as it devastates a select few of us in so gruesome and terrifying a fashion. By “few”, I mean this: Tens upon tens of thousands of deaths is a lot. Relative to the total population, it’s a very little. A long list of other conditions, infections, and diseases affect many more of us. But we don’t shutter the globe in response. We figure it out.
We are likely to get it too, as COVID-19 becomes endemic. This appears to be well underway, as reports roll in of deaths from COVID-19 identified as having occurred in the US in early February. New York just announced a finding of positive antibodies in 14% of a sample of people tested in that state, suggesting that the death rate is closer to one half percent. Why are some of us getting so sick, some of us dying swiftly, some of us feel hit with a bad cold, or some just a minor sniffle, some GI symptoms – or even more peculiar, a fatal stroke? There are more viruses than there are stars in the universe; they are here to stay and part of life on earth. Can we figure out how to live with them, rather than die by them?
Developing a COVID-19 vaccine is fraught with challenges – not the least of which is that corona virus vaccine efforts have posed “unique safety challenges” in that it may trigger responses that vary as wildly as the infection itself. It may kill or injure people, it may cause infection in some, it may give some people immunity, and it may give others no immunity at all while weakening their response when re-exposed. Recently, the World Health Organization (WHO) suggested that immunity to this virus isn’t a protective certainty after infection. If that holds true, then a vaccine may be doomed. The entire premise of vaccination is that antibodies triggered by the injection will protect you. If naturally acquired antibodies don’t work, how could triggering you to make your own from an injected version of the virus work?
Without usual process for safety and efficacy, such as has been proposed in the scramble to have a vaccine, these are ominous frustrations. Peter Hotez MD, PhD is a researcher you may have heard about who has tried to make a corona virus vaccine in the past. So far, no good. In Congressional testimony, he describes unexpected reactions from an experimental vaccine and mentions that two children died (at minute 25:40 in this transcript) in a human trial of his most recent attempt. As a vaccine scientist who invents vaccines, he’d like more than anyone to see this work. In a recent podcast, he eloquently thumbnails what we’re up against. He points out the footdragging the US had on testing and quarantine, which we now know let COVID-19 circulate for a long time. He describes what we’ve all heard many times over too, about who is most at risk, with an odd twist not often mentioned. We know that kids and adolescents are less affected. The elderly are at high risk. Anyone who is immunosuppressed or with underlying conditions is in trouble too. And, this obvious, but rarely stated, twist: Health care workers contract a severe version of the virus, despite their age – young or old. Why? Why don’t they get sick like other exposed young people, and recover?
An opportunity lies there to dig for clues. Health care workers are the most highly vaccinated among us; they receive boosters at least annually for influenza (some workplaces require these biannually), and boosters of other vaccinations more often than most of us likely do. Shouldn’t this somehow be protective? Or is this part of the problem? Detecting a phenomenon called “vaccine interference”, a study of military personnel showed that those with prior flu vaccination had higher risk of contracting corona virus than the unvaccinated: “Vaccine derived virus interference was significantly associated with corona virus and human metapneumovirus”. In other words, in this study, having had a flu shot meant you were more likely to get sick with corona virus.
You might think Dr Hotez would be the loudest on the podium touting a shot as the single silver bullet that can fell this demon. He tried to make one just for this moment, but failed. He knows this can’t happen fast, and that we need action right now. One of the immediate solutions that he and colleagues are thinking of is “convalescent plasma coronavirus therapy.” That is, give immunoglobulin (antibodies to COVID-19) from a recovered person’s purified blood (plasma) and infuse or inject it into a sick person who is not recovering. This worked for SARS, Ebola, and MERS. Development of this biological product for COVID-19 is already underway, despite the WHO nay-saying on this strategy.
Immunoglobulin (Ig) therapy has been around since the 1950s, but not specifically for COVID-19 (no has had antibodies to it, until now). Ig is tried and true, effective, but costly; a pool of many hundreds of recovered persons is needed to extract enough immunoglobulin to treat just one person. It currently costs thousands of dollars per dose, even tens of thousands of dollars per dose, to receive Ig therapy for other conditions, so insurers are loathe to cover it. But Dr Hotez would like to see a low cost version of this made available.
Even if “low cost” means, say, $800 per dose, it sounds great – if you can manage to jump through the health insurance hoops and hurdles that will surely be raised to stop you. COVID-19 has laid bare many ills in the US in 2020, with one of the most glaring being that our for-profit health insurance and health “care” industries are a fail for consumers. There is no covered, federally coordinated access to screening to show who is infected. Millions have spotty access to health care, if they have any at all. It’s more profitable for insurers and care providers to patent and sell a vaccine, than it is to sell immunoglobulin therapy, screen everyone for antibodies, or screen everyone – before exposure – for a laundry list of risk factors like inflammatory markers or nutrients that our immune system draws on to fight infection (ferritin, ESR, homocysteine, serum iron, serum vitamin A, vitamin D, and zinc to name a few). Whether Ig works well or better than other tools isn’t relevant in our care model; whether it’s profitable is.
In Dr Hortez’ podcast mentioned above, he goes deeper into why rushing a COVID-19 vaccine is a bad idea. Among the obstacles is “immune enhancement”, a known phenomenon already seen in animal trials with corona virus vaccines (and others like AIDS) in the past. Industry scientists have long found this phenomenon to be a stumbling block that “proved to be counterproductive” in that it “renders vaccinated subjects more susceptible to infection rather than protects them.” To quote the podcast, “Vaccine trials have begun in Washington which is a positive, but we will also see immune enhancement in [the] volunteer population”. Make no mistake: Researchers know from past experience that COVID-19 vaccine trial test subjects are going to either step on a cytokine cascade landmine (potentially deadly), or suffer “immune enhancement” (potentially deadly if re-exposed), or may be just fine. Here’s how one reader put it, in the comments following Dr Hortez’ podcast:
March 17, 2020 at 4:03 am I think you heard Dr. Hotez correctly: vaccines for highly pathogenic viruses are problematic because they cause “enhanced immunity”. This is a heavy euphemism for the patient’s uncontrolled inflammatory cascade, called a cytokine storm, which causes illness and death in the ebola, MERS and SARS patient. So in a disease whose mechanism of fatality is the host’s immune over-reaction (cytokine storm manifesting as ARDS etc.), vaccines–whose adjuvants aim to “jolt” the immune system into action–can make the reaction even worse. This is one reason why a SARS-1 vaccine development was halted; although the mice survived the vaccine fine, they were dying at high rates after they were re-introduced to the virus after innoculation. For this reason, therapeutics may be the better solution to this SARS-2 virus than a vaccine.
What to do? Hopeful puzzle pieces are emerging. Persons with healthy immune systems show promise for recovering, provided that their immune systems do what they’re built to do, without going haywire.
Immune systems are complex with lots of opportunity for “haywire” to happen. The good news is, we can minimize the haywire and build functional, meet-your-COVID-exposure-safely immune performance with nutrients, food, supports for inflammation and detoxification, and with better monitoring and management of our own risk factors. So far, policy and practice in the industrialized world around infectious disease mostly disregards all that. On a policy and practice level, we haven’t looked much into how to enhance our own immune response so that it is balanced and effective, or why some immune systems do it right while others get it wrong. We’ve focused on drugs to control symptoms during infection, on vaccines, and on drugs to kill infection. But COVID-19 is shaking these foundations to the core. These 20th century strategies are failing us with this one. This is grim, but it means there is opportunity to pivot and integrate some cool new stuff. Practitioners in the functional medicine realm have been doing this all along. Some pearls have already emerged, more are sure to follow.
One shockingly simple finding may be right under our noses: Severe COVID19 patients can have dramatically high levels of ferritin, even exceeding a value of 1000 ng/mL. This is a very high level that reflects intense inflammatory process underway. Ferritin is a means to make iron safe in the blood. It scoops up free iron when iron, a powerful oxidative stress element when free in the blood, gets too high. This high level of iron will set off inflammatory cascades in itself and slowly poison patients. It’s possible COVID19 is doing this by knocking iron off of the hemoglobin on red blood cells, so it to floats free in the bloodstream. No iron on hemoglobin means no oxygen can attach to your red blood cells, and you will essentially suffocate while the inflammatory cascade is encouraged from too much iron.
A simple way to oppose iron is to supplement zinc. COVID19 patients who report a sudden loss of taste and smell are reporting one of the classic textbook signs of zinc deficiency. They may be rapidly depleting zinc to meet demands set off by infection. This may be just one of the trip-wires that sends some patients into a rapid decline, while others muddle through. It’s not exotic, but it’s worth exploring. It would be a lost opportunity if it were true but instead we took a detour into how COVID19 might affect olfactory nerves.
COVID-19 is ruthless and devastating for the vulnerable among us, and incidental for most of us. If we follow our own hallowed tenets of epidemiology and herd immunity, according to Scott Atlas MD, a health policy expert at Stanford University, the most protective-for-all thing to do is to “stop the panic and end the total isolation”. That is, go back to work, come out of hiding, and build population immunity naturally, while identifying and supporting those who are at risk. We have tools at hand right now, and they may be deceptively simple. From tapping older less profitable drugs (less profitable because they are off patent and available generically) to engaging essential tenets of the nutrition / immune interface, we have a lot to work with already.
About The Author: Judy Converse MPH RD LDN is a licensed registered dietitian nutritionist. She holds a master’s degree in public health with nutrition major from University of Hawai’i / Manoa and a bachelor of science degree in human nutrition from University of Vermont. She has lectured widely and authored several books on pediatric nutrition and specializes in nutrition intervention, monitoring, and support for children in her private practice. She has worked with health insurers on nutrition service delivery and with industry partners on medical foods.
I’ve been in pediatric nutrition practice for some 20 years, but these health and nutrition myths just won’t quit. They can keep kids sick when they could be enjoying better health. Here are 7 myths I encounter week after week. They’re powerful enough to steer your kids away from health and into being more sick, more often. Change your mind about these myths, and your kids may enjoy more health, more often.
Myth #1 – It’s normal for toddlers to be sick all the time …Um, not quite. Common? Yes. Normal? No. A toddler who rides a roller coaster of colds, infections, stuffy noses, coughs, diarrhea, or malaise every month, for more than 5 or 6 times a winter, with or without fevers, or who needs antibiotics over and over before age 2 or 3, gives me pause. So does a child who never gets a fever, but isn’t thriving either, and is often fatigued. Kids should not be sick more often than they are well. Yes, little tykes are vulnerable; their immune systems are developing, and if they were not breastfed, they haven’t been given that powerful foundation from mom’s immune system to protect them.
A cold or virus with a vigorous response – like a fever to 103 or so – that drops your child for a few days is a healthy and necessary challenge for the immune system to develop. But toddlers should bounce back, and resume a hearty eating pattern to restore depleted nutrients burned up during illness.
Nutrition and food make it possible for the immune system to work. When we’re sick, we make big withdrawals out of our nutrition bank accounts. For growing toddlers, this is especially costly – like borrowing money on a 25% interest rate! They need a lot of strong nutrition for growing, and for fighting illness, when they’re sick. We store nutrients for these occasions – especially iron, zinc, vitamin A, and vitamin D. We also use our own protein – which we store in functional structures like our organs, bones, muscles and flesh – to help fight infections. So if a child has a weak growth pattern to begin with, or is even just a little bit underweight, there won’t be much to work with if illness keeps knocking him down. A downward spiral of malnutrition and infection can ensue, and this is dangerous for tots.
PSA: Here we go with everyone’s favorite topic… The shot schedule. My 2p? It’s overloaded, fails often, and creates opportunity for mutation into more virulent strains of the viral and bacterial material in the shots. Vaccines can also cause the infections they are meant to prevent, such as in this case. The medical community understands overuse of antibiotics and has made big efforts to cut this back. Not so with vaccines. There is a mania that more are better. Believe me, my public health master’s degree gave me full indoctrination into immunization theory and practice. But these practices are not working, and after 20 years in clinical practice, I’ve had an about face. Despite having many more vaccinations than ever, kids are more sick and disabled than ever in US history, and not a single “vaccine preventable” disease has been eradicated. It is not because your neighbor opted out. It is because natural, long lasting, robust immunity from actual infection has all but vanished, and because vaccines can spread infection.
Vaccinated people can shed and spread infection from recent shots. This is called “secondary shedding”. Evidence of this is documented for flu vaccines, chickenpox, measles, polio, and many others. If you’re seeing your kids get sick when school starts…. it may be because everyone just got vaccinated and is shedding infectious material. Check out this sign at my neighbor’s condo association pool, barring anyone with recent vaccinations:
Dilemma: Your pediatrician’s bread and butter is giving vaccinations, and prescribing drugs. That’s about it. Since their degree required little to no deep training in nutrition, they may not recognize nutrition problems that drive frequent infections. If your child is sick more often than well, if colds and infections just won’t quit, what to do?
- Have your child’s levels of quantitative immunoglobulins checked. Low immunoglobulin means low defenses. Good nutrition and food build this back up eventually, but other special measures may be needed.
- Improve your child’s growth pattern. Are they underweight? Are you sure? Even being modestly underweight may drop immune response and defenses.
- The immune system needs iron. When it’s depleted, infection fighting is harder.Check iron status with a full iron study, not just with hemoglobin (Hgb) and hematocrit (Hct). Hgb and Hct are crude measures that capture only profound anemia. Ask your doctor to do a full iron study to see if your child is pre-anemic. An iron study includes ferritin, serum iron, transferrin, and saturation. Don’t start iron supplements without guidance – iron can be poisonous at the wrong dose.
- Get your child’s vitamin D level checked. It should be well above 30. At our office at Flatiron Functional Medicine, we look for levels in the 50-80 range for good immune protection.
- Get your child’s vitamin A level checked (also called serum retinol). Vitamin A is crucial for immune function, and upper respiratory infections, measles or chickenpox in particular. Unless your child likes to eat liver, cod liver oil, lots of fortified dairy food or grass fed butter, and/or orange and green vegetables, a marginal or even deficient vitamin A level may ensue. Marginal or deficient vitamin A places your child at higher risk for complications from measles or measles vaccine.
- Don’t vaccinate a sick child.
- Breastfeed as long as you can.
- Camel milk is a good source of potent immunoglobulin. Consider using a few ounces daily. If that’s just too weird, consider using a bovine serum derived oral supplemental immunglobulin like this one, or colostrum, if your child tolerates milk protein.
- Keep your child home after vaccinations if they don’t feel well. Avoid recently vaccinated peers just as you would avoid a sick child.
- Balance your kids’ meals and snacks so they get about a third of all their food as fats or oils, about half as clean, non-processed, non-sugary carbs, and about 10% as high value protein. Vary the protein they eat, so it isn’t always the same source.
- Use as much organic food as you can afford. Pesticides in food burden the immune system further.
Myth #2 – Picky Eating Is A Willfull Behavior Choice ….Followed by “your kids need feeding clinic” (maybe they don’t) and “they’ll grow out of it” (I have many kids in my caseload in their teens who …didn’t). Nope nope nope.
Picky eating is a downstream effect of three things: Gut dysbiosis, mineral imbalances, and exogenous opiate peptide formation from wheat, dairy, soy and pea protein (like Ripple milk, or plant based protein powders). Watch this short video for a fast explanation.
What sets this up? Reflux medicine, C section delivery, antibiotics (for mastitis, at delivery, during pregnancy, for your child, or a long history of your own yeast infections and dysbiosis prior to pregnancy), early vaccinations… That’s where it begins. This parade of interventions and pharmaceuticals from birth insidiously but profoundly change the gut biome away from a healthy early profile and toward disruptive microbes like Candida, Rhodotorula, Klebsiella, Prevotella, too much Staph or Strep, or even Helicobacter pylori. Sometimes I will see a protozoan pop up on DNA screen stool studies too. These in turn usurp minerals out of the diet and make them harder to absorb too, due to subtle shifts in pH in the digestive tract that these microbes create. Ultimately, appetite can drop, the poor diet begets more poor diet, because weak zinc and iron status tend to trigger pickier eating. Next, this scenario also degrades digestion of proteins. When proteins like wheat, dairy, soy and pea are poorly digested, they become “dietary exorphins” or “food derived opioid peptides” that trigger effects on the nervous system.
Once this is in play, your kid is indeed addicted to that white diet (Goldfish crackers, yogurt, noodles, milk, milk, Pediasure, milk, more milk, cheese, pizza, mac and cheese, pasta, bread… and of course sweets). Other foods will be absolutely refused even if you let your child go hungry – because other foods don’t give that opiate-like kick. There is literally addiction chemistry here working against your child. Sure tells that this is happening to your child, besides the fierce picky eating, are hyperactivity, behavioral volatility, dilated pupils after meals, and/or delays in expressive language or socialization.
Breaking this pattern can be done. I’ve helped hundreds of families break it, and it has nothing to do with convincing your child to like something else, or sitting through agonizing feeding clinics where your child is pressed to place different foods to their lips against their will.
Full disclosure: The only thing that makes a nutrition intervention, and not a behavioral one, for this fail is when parents bemoan how hard it is. Yep, it’s hard. But it can be done through a methodical reboot of your child’s gut environment, with individualized strategies for supplements and new foods. Start with this e book if you want to break picky eating. Spoiler: Probiotics alone won’t fix this.
If your child has mechanical issues with swallowing and feeding, then of course they need feeding therapy. For other kids, unless the underlying nutrition and gut biome problems that cause picky eating are professionally assessed and corrected, feeding clinic may not be necessary or helpful.
Myth #3 – Kids Get Constipated Because They Choose To Hold Stool – Gaining potty skills is a process for sure, and some kids do get flummoxed around it to the point of trying hard to withhold stool. In 20 years, I have had one legit case of this. For all the hundreds of other kids, they were constipated because of (a) disrupted gut biome and (b) dietary exorphin formation.
Most of these kids had Candida or fungal microbes flourishing in their intestines. How did we find out? We did urine and stool studies to show it. These are not yeast infections that their pediatricians noticed – because the kids didn’t seem outwardly sick, didn’t have immune suppression, and didn’t even always have white flecks in stool, white or grey coated tongues, flat or concave nails, or ringworm rashes (all tell tale signs of fungal dysbiosis). What they did have were bloated bellies that wouldn’t quit, fierce cravings and picky eating for starchy processed food or sugar, behavior challenges, lots of Miralax in their histories, and, constipation. Some of them also had epic battles with bedwetting into their tween years, which turned out to be a Candidiasis of the urinary tract.
Clearing the dysbiosis does the trick. This takes thoughtful intervention with probiotics, antimicrobial herbs, or in some cases, prescription anti fungal drugs, as well as some upgrades in what these kids eat. I choose all this stuff based on each child’s history, labs, and presentation.
The other constipation trigger here is the opiate peptide business (See Myth #2). Casein digested into casomorphin, or gluten digested to gliadorphin, are both powerfully constipating – after all, they have opiate-like effects, and if you’ve ever needed pain killers for a surgery, you know the drill. In some cases, the constipation doesn’t quit til those proteins are 100% strictly removed for at least three months. Because soy and pea protein concentrates do the same thing, swapping out milk or wheat protein for pea or soy can fail. Ripple milk, Vegan Orgain, and any plant based protein powder may have pea protein concentrate or soy in it and will continue the constipated pattern in some cases. Digestive enzymes may help, but this isn’t as effective as removing the offending foods. If you use enzymes, buy one that has dipeptidyl peptidase IV in it (DPPIV) at a high concentration. After some gut repair and good nutrition replenishment, wheat and dairy may be fine once again, but don’t expect results from a reduced intake of these foods – they may have to entirely vanish to get your child pooping again.
Myth # 4 – If my pediatrician didn’t say so, it’s not real – The American Medical Association and the American Academy of Pediatrics don’t require rigor with respect to nutrition, for those getting MD degrees with specialty in pediatrics. Only about a third of doctors routinely discuss nutrition at clinic visits, and most report they don’t feel adequately trained in nutrition (they’re not).There are big knowledge gaps for pediatricians when it comes to nutrition. So when you go in with questions about foods, supplements, or special diets, you may come out empty handed at best, or chastised at worst. Don’t stop there, or assume there isn’t a solution, if your pediatrician can’t answer your questions or tells you there’s no evidence that a nutrition measure might matter.
Odds are, there are some very good data on whatever your question may be. Nutrition is a thoroughly pedigreed science that has been around for well over a century. There is so much possibility to engage information, research, and clinical experience from it that your pediatrician may not know about. Naturopathic doctors have more training in it, as does a pediatric nutritionist/dietitian (that’s me). Adding these resources to your care team can give your child better odds for better health.
Myth #5 – Cavities? #ThisIsFine – Cavities are no fun for anyone. Even kids who have good oral hygiene can end up with repeat visits to the dentist, for drilling, filling, capping, or extractions. It may seem entirely usual that everyone gets them. Well, not everyone does, and no, cavities are not a necessary childhood rite of passage.
Cavities are a canary-in-the-coal-mine scenario. They can be thought of as a flag for a disrupted oral microbiome, and/or a shortage of the strong nutrition that helps build teeth and enamel. A healthy mouth will harbor friendly microbes that do a good job of intervening on your behalf, and don’t let an overly-acidic environment erode enamel. And, a baby who gets to breast feed a long time will have a better shot at less crowding of the teeth, and thus less chance for cavities.
If your child has a frequent flyer punch card with your dentist, start with gut. Your child’s gut microbiome may need an overhaul away from Candida, yeast, Helicobacter pylori, or other disruptive species. These are fed by simple carbs, sugary food, and processed foods. If your child is picky, see Myth #2 above, and set a goal to bust that pattern. Ditch the reflux medicine if possible (if you’re using it), because this reduces absorption of both protein and minerals – two key components of teeth. If children have optimal nutrition during the time that teeth develop, they can avoid cavities. Vitamins A, D, K, and C along with healthy fats and protein, with wholesome vegetable sources of carbohydrates, can accomplish this task. For more on nutrition and cavities, visit the Weston-Price Foundation.
Myth #6 – Measles and chickenpox are deadly diseases. The short answer here is, yes, and, no.
So much has been said about this in recent years – most of it counterproductive – that it’s hard to consider bringing this up at all. As a senior practitioner who has been credentialed in my field for over 30 years, I can say the sea change in this has not been worthy. It has not translated into better health for children. The conversations now afloat, where anyone questioning vaccines is pilloried and branded insane, would have been shocking during my graduate studies the late 1980s. We were allowed, and encouraged, to question and investigate, as were our mentors and instructors. This was not forbidden in that day, as it is now. And yes, I studied immunization, epidemiology, and nutrition as a graduate student. Yes, I know of deaths from these diseases. Among my classmates were physicians and health professionals from Taiwan, Indonesia, Africa, Egypt, Pakistan, Vanuatu, Guam, and the like. For our graduate practicum rotations, we were flung to all corners of the globe, including underdeveloped locales where poverty and malnutrition were common. My classmates went on to positions in clinical practice as well as in policy, including for WHO, USAID, and the CDC.
Measles can kill a child in poor nutrition status. So can chickenpox, flu, or a common cold. Here is the lost part of the conversation: Nutrition, not vaccination, makes or breaks this for a child. For decades, the World Health Organization (WHO) has emphasized nutrition protocols for controlling infectious diseases, and for measles in particular (see Table 1 here for just one example and Table 2 here for another). Why? Because the immune system only works if it has nutrients to draw on to make immuglobulin, white blood cells, NK cells, a thymus gland, and so on. It can’t work from just a poke in the arm with a bunch of antigens and toxic adjuvants in it. It needs the body’s nutrients to respond. My classmates in public health knew this, witnessed this, and applied it. They did not go on caterwauling about vaccination, condemning people who deferred, or indulging emotional, religious-fervor, carte-blanche approval to using vaccines without limits. We understood that nutrition status was, and still is, the primary driver of whether or not a child may die from an infectious disease, have complications, or survive it handily. Whether you derive it from an injection or a natural infection, there is no immunity without nutrition to build it – period.
This is now so polarized a topic that effective discussion is impossible. Young parents have succumbed to relentless fear mongering and misinformation from the pharmaceutical industry (via its alliances at the AAP, FDA, and CDC) while actual science has fallen by the wayside. Millenial parents are in lock step out of fear of becoming social pariahs, willingly submitting their children without question, lest they be accused of being “unscientific”. At the same time this generation can grasp that the oil industry has lied about climate change since the 1960s, it is somehow lost on young parents that the pharmaceutical industry is, likewise, lying to the public about the safety (and efficacy) of its single most profitable sector. As long as pediatricians remain poorly informed on nutrition, they too will readily believe that an ever growing vaccination schedule is the only way to have immunity to anything. It isn’t.
For kids in strong nutrition status, measles and chickenpox are survivable and beneficial infections. Not only do these infections give effective immunity that lasts into adulthood, having had acute fever inducing infections in childhood like measles may lower risk of certain cancers later in life. Strong nutrition status means robust stores of iron, zinc, vitamin A, protein; access to clean whole foods and the appetite to eat them; and a body mass index somewhere between the 25th and 80th percentiles.
Nutrition and infection is a vast and complex topic. Our pediatric physician community is tragically not well versed in it. Hence, we have a nationwide army of pediatricians believing that only vaccines can prevent infection, while at the same time depending on giving them for their livelihoods. The truth is, not a single disease has been eradicated by vaccines so far, and like any other pharmaceutical product, it may not suit everyone. The strong arm tactics afoot to force vaccination are highly suspect – if a product truly works well, no one would object and no one would need to be forced to use it. In fact, vaccination itself may have loosed more virulent strains of several previously mostly benign infections, besides destroying the natural immunity that humans developed over eons of time.
If your child contracts either measles or chickenpox, consider these guidelines from Mayo Clinic. If your child has been growing well, eating well, and not picky prior to illness, odds are they will have the nutrition reserves to weather this successfully and will be gifted with robust immunity for many years. Vitamin A is crucial for fighting measles. Supplementing it during this illness may be necessary. If your doctor doesn’t know how to do this, see these WHO guidelines (Source – see page 45):
Myth #7 – Elimination diets will make my kid different and there’s nothing to eat anyway – When I became a mom, despite my degrees in nutrition, I knew virtually nothing of elimination diets or food allergy. I soon found myself on a steep learning curve. This was in the mid 1990s. No internet, no online support groups, no other moms in this boat. I was isolated, and cracking into my training, texts, and visiting medical libraries all over again, just like in graduate school. My son needed to eliminate gluten, soy, egg, dairy, and nuts back when nobody did this. Nothing could be bought ready made, including bread (we eventually found Kinnikinnick bakery in Canada, but that was the only one for years). I was often quite unwelcome at school events, family gatherings, or birthday parties because I would show up with “weird” food that my son could eat. I always made enough to share. I always asked hosts ahead of time if this was okay. Eventually, it was …fine.
We didn’t talk a lot about this in my house. We just made food. It wasn’t my son’s problem, it was mine. I was the adult, and it was my job to give him the freedom to eat and feel good, rather than eat and feel sick, like any other kid. If anyone had a problem with that, well, insert expletive here. He gets to be well and happy too. This was my mantra.
This made me learn a lot about food, cooking, and baking that I didn’t know. I learned how to make really good food and really fun and delicious treats for holidays and birthdays. It made me do a better job than I would have, of feeding my family.
If I could do it in the dark ages, you can do it now. There is so much awareness for food allergy now, not to mention thousands of food products out there ready to buy, mix, cook, bake, or just eat. Get to it. If you need help, let me know.
How do you get your kids a decent lunch at school? You’re over the top with beautiful Bentos, containers, and boxes for all the best snacks and sandwiches you can think of, you’ve tried every healthy power bar, fruit, carrot sticks, rolled up turkey, hummus… You’ve resorted to the junk: Cheddar Bunnies or Goldfish, pretzels, chips, sugary granola bars… and it comes back barely touched at the end of the school day, right? Or you’re buying school lunch, but have no idea what it is, whether your child eats it, or why they come home and melt into tantrums day after day (hunger, maybe?) Here’s five tips to help this go a little better.
1 – Let yourself off the hook – and your kid too. You’re not the problem. Neither is your child. The school is. Lunch is too short, too chaotic, and too impersonal. Incredibly, some children literally don’t get to eat lunch at all, as they spend too much time lining up to get it and finding a table. Here is one example of a school where children actually dumped untouched trays of food in the trash because it was time for recess by the time they’d gotten their lunches – they never got to eat at all. No amount of curriculum is worth this. You can stuff curriculum into kids’ faces all day if you like, but guess what? It won’t work. Because when children are hungry, attention and learning drop. Hmm maybe this is why we hear that US kids are falling behind compared to other countries?
By contrast, check out this story and video about how school lunch is served in France. Imagine how differently children learn to value food, community, self worth, and social interaction, when they get to eat this way. Oh well. We are probably not going to get there anytime soon in the US. But I share this to illustrate how absurd it is to expect children to function well in our version of a school lunch system. It does not engender health, good digestion, or appreciation for food, self, or how to contribute to a positive group experience. Our system is downright competitive, and anxiety provoking, as kids must worry about what they’ll get, when they’ll get it, if they can eat it, how fast, where to sit… and must do it in a cacophony that could make your ears bleed. So give in to the fact that how your child eats at school is something you can’t likely change, at least not this week. Make up for it with family meals at home as often as you can, whether it’s breakfast or evening meals. Having family meals together on a regular basis has been shown to boost kids’ vocabularies, grades, and intakes of nutrient-dense foods.. and it lowers high risk behaviors in teens like drug use and drinking.
2 – Let your child eat what is easy during the school day. Literally, anything is better than nothing. Pack high protein finger foods, starchy snacks (yes, you read that right), and comfy favorites. Don’t worry about the carrots and celery that come home. They’re not going to help much anyway during the busy school day. Your child needs high density food. Their brains use nearly half the total food energy they eat every day, just to be and learn (adult brains use about half that amount). Starchy snacks give fuel quickly and while we can argue all day about why they’re bad, they are better than nothing. Think of it this way: You’re flight was delayed and your stuck in an airport terminal at 4 AM with nothing open for food. You never had dinner the day before or breakfast this morning. But wait: You found some crackers in your purse. Eat them, for God’s sake! Yes, it’s junk, and, it will give you a little help til you get to your destination. It’s not what you’re going to eat every day, but you’re glad to have it in that moment. Likewise, don’t sweat it if your child is eating some low value starchy snacks during the school day sometimes. Avoid processed high sugar or corn syrup snacks – but a blondie brownie (gluten free if necessary), made with strong organic ingredients, coconut sugar or maple syrup instead of cane sugar, and some awesome ghee or coconut oil for a brain boosting fat isn’t at all that bad. If allowed at your kids’ school, throw in some crushed cashews or other safe nut. A dense homemade or store bought bar every day with clean ingredients isn’t all that bad.
Lunch at an Iowa school, 1939 (courtesy Library of Congress)
3 – Fast finger foods are an obvious help. Expand on the starchy goodies by including some protein and fat rich options, like olives, hard boiled eggs, jerky or meat sticks, or collagen bars like BulletProof, Dr Axe, BonkBreaker, Caveman, or Perfect Bars (some from this brand have peanut). Other bars may source the protein punch from dairy, using whey or casein; you’ll need to skip those for a dairy free child. You might also see soy, rice, hemp, or nuts as protein sources. Scrutinize ingredients to fit your child’s needs. Generally, grass fed collagen is a good protein source that is non-allergenic for most kids. Another great option: Fat bombs, bite size power packed snacks that are easy to make at home with a few ingredients, and are beginning to appear on store shelves in various forms. Here is just one site that offers a cache of 45 fat bomb recipes. Look around the web for more from sites like Paleo Hacks, Paleo Plan, or under names like Paleo Energy Balls. Those recipes use nut butters often; some schools have a zero nut policy while others only limit peanut or have a nut free table. Lastly – macadamia nuts, if allowed at your child’s school, have the highest fat and calorie content of any nut. Even a few nuts give high octane fuel that can make the day’s journey easier. Ten nuts yields about 200 calories. Throw in a few organic, stevia sweetened chocolate chips if you want to make it a treat that skips sugar.
4 – Make the liquids count. Instead of juice pouches or boxes, consider a midday meal replacement power shake that adds fat, protein or micronutrients. Options abound for ready to drink stuff you can pack in your child’s lunch. Orgain drinks are widely available (even at Costco) in both vegan and dairy protein source versions. The vegan version is gluten, dairy, and soy free. I also love Rebble Protein Elixirs. A little pricey, but they are dairy, gluten and soy free, with big protein boosts from pea, sunflower, pumpkin seed, or hemp. They are less sugary, more nutritious, and cleaner than stuff like Boost or Pediasure, which are high corn syrup and low nutrition value with only GMO fed cow casein and GMO soy as the protein sources.
Many kids with severe allergies need an even more specialized product. One example is Splash ready to drink elemental formula for children. Though many in the integrative nutrition communities love to hate this stuff, in certain cases, I have seen it be quite successful for children with feeding difficulties and multiple food allergy. Downside: High cost, but may be covered on insurance for kids with documented multiple food allergy.
You can of course also always make your own smoothie and send it to school in a single serving container, but keep in mind that this makes more work for you, and it may take more steps for your child to eat it than products that come with a straw or easy open cap.
5 – If all else fails and your child is simply not eating lunch, meet with your school principal and teacher to troubleshoot. Ask if you can observe a lunch period, volunteer during lunch, or work with an advocate to observe for you, so your child isn’t seeing you at school to watch lunch (they will most likely behave differently in your presence). Is your child last to get to the table, struggling to know where to sit, klutzy with the tray tasks, overwhelmed by noise, too excited to socialize to eat? Identify what is not working. Solutions might be quieter seating with a lunch bunch rather than in the cafeteria en masse, leaving two minutes sooner to get to cafeteria with a peer, or reliable seating at a regular spot. Further ideas are talking to your principal about aligning recess before instead of after lunch, expanding the lunch period by a few more minutes, or creating conduct rules at lunch for noise or behavior for the whole school. In my son’s elementary school, lunch included clear conduct rules that meant no one left the table until everyone had finished eating and had cleared their trays/lunch sacks and trash. This meant that at the end of the half hour (yes, they had 30 minutes), twelve little angels were usually seated quietly waiting for the signal for the whole table to go out and play. Rather than bench seating or loose chairs, the cafeteria had tables with single circles integral for each little behind, like this. These omitted crowding or jostling for space. Find power in numbers with other parents for these larger changes.
When I was a kid, we actually got bussed home in the middle of the day for lunch. My school did not have a cafeteria. We were picked up, brought home, I had lunch with my mom and siblings, and got back on the bus to go back to school. I had a full half hour to eat once home. I never felt rushed or worried about lunch. It’s hard to believe this is how it used to be in an American public school. Times have changed, budgets are squeezed, moms aren’t home to serve lunch. Maybe someday our school system will reboot how it does lunch time to something more conducive to learning, but until then, give your child these options to at least get through the day on more than fumes – they deserve it!
Let me tell you the five most helpful to-do’s I have seen parents use for their children’s health, as we start a new year.
These come from my twenty years’ experience working with families in my pediatric nutrition practice – with mostly complex, difficult cases who couldn’t find improvement elsewhere. In other words, even if your child is really challenged with feeding, growth, chronic illness or disability, developmental trials, allergy or more, I can tell you that these five tips are still my top picks, for setting up the healthiest foundation possible for your kids.
You might think I am going to talk about stuff like picky eating, junk food versus organic, gluten, food allergies, eating more vegetables, probiotics, vitamins, the latest autism protocol, whether or not you should do GAPS, gut biome… Nope. I definitely do cover all that and more in my clinical practice and in my blog, so have a look around.
These tips are about you – and how subtle shifts in your approach to health and what your family eats can cause unexpected benefits to unfold in everyone’s health.
1 – Get fierce about this: Adopt the mantra that health – not illness, disability, endless doctors’ appointments, or dependence on prescription or over-the-counter drugs that bring unwanted side effects – is your child’s birthright. It’s the baseline they are entitled to. Picture them at their healthiest and happiest. Imagine the unimaginable, if that is what it takes. Start with that picture of the joy good health brings.
If they’re not there, if your children are saddled with chronic illness, don’t lament, and definitely don’t feel sorry for them – they have you as their advocate and model, and they need positivity and possibility. Hold that image of total health that they need and deserve. Assume they have it already, and lead the way toward it, quietly and persistently. Expect a good outcome. Their bodies are built to grow, heal, and restore. There is always potential for healing.
2 – Chill out about food. Robyn Obrien’s 80/20 rule is a comfortable sweet spot. Her suggestion is to work for “progress not perfection”. Unless you know your child will sustain severe injury or consequences from eating certain verboten foods which must be avoided, don’t pathologize food. Don’t judge. Don’t chatter about how horrible this or that food is.
I encourage parents to use empowering language, even with small children. I discourage labeling food as “bad” or something that will “make you sick”. This can burden children – even teens – with unnecessary anxiety.
Instead, use words that show the power to choose. If your child eats something that backfires into discomfort or behavioral disintegration, ask which food might feel better next time, if they’re old enough to consider that question for themselves. If not, tell them what you will do next time: “Next time I’ll have xyz ready to eat instead, and you can see if that feels good”. Or “I’ll give your teacher a new snack for you at school. Maybe that will feel good instead.” Don’t harp on what a mistake a transgression was, especially if your child made the choice or if the choice was beyond their control. That is too easily internalized into feelings of powerlessness or failure by a child.
Notice your phrasing, demeanor, and tone when talking about food and health. Leave out the dark, judgmental stuff and emphasize food feeling good, tasting good, or being fun to share or experiment with.
3 – Read food labels? Now try this. If you’re like most parents I work with, you read food labels ad nauseam. You scrutinize every ingredient that passes your child’s lips – especially if you faithfully eat only organic food, avoid corn syrup or dyes, or if your kids ever needed an Epi Pen for eating the wrong thing!
Great. Now try this: Read a vaccine package insert. Read the whole thing, including the ingredients (often listed under the word “Description”). If you care about what’s in your child’s food, you will definitely want to know what is injected into them.
This is a great resource to see the full insert for each vaccine in the schedule. To see ingredients, search for the word “description” (which – as you may wonder – does not necessarily disclose all the ingredients, some of which are allowed to be proprietary, per the FDA).
I’ve met many a mom worried about letting their kids eat, say, corn chips or dairy (because they heard either was “bad” for everyone) – but never knew that Prevnar 13 – just one of dozens of shots on the schedule – has GMO soy fragments in it. Or that Recombivax has yeast, soy, formaldehyde, dextrose, and aluminum in it.
Recombivax is given to newborn babies. If you wouldn’t let even traces of GMO soy, formaldehyde, or aluminum touch your newborn baby’s tongue, why would you let these be injected? Note that eating any protein – or toxin for that matter – is far safer than injecting it, especially if your child is prone to any sort of reaction.
No need to dwell on what a contentious conversation anything with the V-word is, or indulge the drama and emotional reactions to this topic (I’ll delete comments that do). I get it. My graduate training in public health was full-on pro vaccine. I don’t need any instruction here, thank you very much.
It’s just that it’s high time for common sense. We talk a lot about food ingredients, including traces of glyphosate in GMO foods. Nobody talks much about ingredients in your kids’ shots. The “trace amount” argument loses traction once you see that kids receive anywhere from 70 to 100 doses in their first five years, when they are the most vulnerable to the burden of toxic exposures.
It would be fabulous if there was a pharmaceutical or biological product that actually was reliably, equally safe and equally effective for every kid or baby, every single day. But that is just magical thinking. There is no such thing, anywhere. Not a food, not a medicine, not even a fragrance. Can you imagine if it were mandated that all public school children eat Adderall every day, because some kids are too hard to manage in the classroom due to ADHD?
So this is why my Number 3 is for you to learn exactly what’s in your kids’ shots (or yours, if you’re planning on getting pregnant). They are potent. Don’t take them lightly. They may be helpful, or like anything else, they can be harmful. Too many may overstimulate the immune system to cause problems later on. Learn what is in vaccines, when they’re given and how often, and scrutinize if your child really needs them all.
For example: Your child won’t need boosters if they retain immunity from a prior dose – more may not be better.
If you’re upset because someone gave your kid a bag of Skittles at school, then wig out about the kid next door who skipped chickenpox vaccine, I think you’ve got it backwards. Just my opinion.
Besides, don’t you believe your own kid’s chickenpox shot worked – ?
In this scenario, the candy may be the lesser of two evils. Chickenpox vaccine is made with human fetal DNA, guinea pig embryonic tissue, sucrose, glutamate and MSG, and fetal bovine serum. Check out page 6 under “Description”.
4 – Heed your intuition. It’s a powerful healer, guide, and protector for your kids. And at the same time, remember that intuition is not a mandate for you alone to know everything!
In all my years as a clinician, I can’t tell you how many times I’ve heard a mom say “I just had a feeling” …and how often that feeling was right. I’ve certainly had that moment many times myself as a mom.
It can be tough to go against the advice of the expert specialist at the Mayo Clinic, but you can do it if you simply feel you must, even if you don’t know quite why just yet. You know your child best.
Don’t confuse intuition with fear, or with the egocentric idea that only you can help your child. While I’ve often seen a mom’s intuition impressively steer a child to a good outcome, I have also seen families withhold good care options or block alliances with good providers, out of fear that they shouldn’t trust anything, or a belief that only mom can know what to do. Neither approach is very successful.
Look for your allies and resources, know your own strengths as well as spots where you could use help, allow the help in, and remember – you do know your child best.
5 – Drop the drama. When we have kids with struggles, it’s so easy to be seduced by the drama of what it takes to be their parent.
It’s easy to over-identify with the tasks of caring for kids with learning disabilities, developmental concerns, feeding and growth delays, allergies, and more.
Don’t do that. It messes up your kids. They’re not here to fulfill you in some way, or address your needs. They’re just here. Pretty much, to be themselves.
I meet traumatized families. Families who have had too many trips to the ER for severe allergy reactions from an accidental walnut, for seizures because a medication keeps failing, for passing out because of FPIES reactions and non-stop vomiting. For these families, a plain old broken arm sounds pretty good. Families isolated by too many dietary restrictions, by developmental disabilities including autism, anxiety disorders, or processing disorders.
I meet families who have been verbally battered or treated with great insensitivity by doctors, teachers, neighbors, or even friends or family members. Trusting becomes hard. As a parent, it’s hard at times not to feel victimized, to feel like the hardship with your kids may never end, and to lapse into the trap of believing that this whirlwind of medical/developmental/educational crises is… your whole and sole self.
But this isn’t about you.
Underneath and in between all that, there is your child, endeavoring to just be. Like any other kid.
The kids who come out of these tempests with the best outcomes, in my experience, are the ones whose parents can remain aware of this. These parents do not attach their own pain, ego, fears, sadness, disappointment, frustration, or feelings of inadequacy to the child, or to the outcomes. They don’t focus on diagnostic labels, whether it’s eosinophilic esophagitis, PANDAS, autism, Crohns, FPIES, or whatever. They rarely if ever use the labels around their kids, because they know their kids are not the labels. They obtain the labels as a path to health and wellbeing as is useful – that’s it. They don’t spend too much time on Facebook groups devoted to their kids’ labels. They focus on actionable solutions. They trust the fact that as parent, they are doing the best they can.
You’re in charge. You set the tone. Your kids will follow suit, even if they have seemingly insurmountable challenges on their plates. I used to hate it when my mother advised, “don’t complain, don’t explain” …but, she was right.
Everyone has heard about probiotics – but how do you know which are friendly and helpful, and which are UN-friendly and detrimental? Not all probiotics are all friendly, all the time. The microbes in probiotics vary in the sorts of tasks they do for us – so, depending on when, what, and how you’re using them, they can be a big help or a big fail.
Probiotics are bacteria or yeast supplements, in case you missed the memo, that you can buy and eat as a supplement. There are powders, capsules, chewables, probiotic foods and drinks… you name it, it’s out there. The idea is to help populate your intestine with the types of bacteria that keep you healthy. Turns out we really need bacteria, viral exposures, and even some fungal (yeast) species to co-exist with us. These help our immune systems stay robust and direct traffic – especially at the gut wall lining, where our insides meet the outside world.
What’s in a human gut biome, and what species of microbes do what, is a burgoening area of study in medicine and health. While the old paradigm believed in a kill-all-germs and take-no-prisoners approach to immune health, the new paradigm has noticed that this doesn’t really work – because it makes people have more allergy, more inflammatory conditions, more autoimmune problems, and possibly, more susceptibility to serious conditions later in life, like cancer. A great example of this is how exposure to infections like measles and chickenpox in childhood protect us later on from certain cancers or shingles. But, now that we so enthusiastically use antibiotics, vaccines, and cleansers to keep germs at bay, we’ve really altered our human immune-scape!
Enter probiotics. Using these really can help many conditions, symptoms, and problems – from asthma and allergies to colitis or obesity.
But what if you use them and your child feels worse?
You may be using the wrong probiotic at the wrong time for the job.
One of the most-often misused strains I encounter in my pediatric nutrition practice is Saccharomyces boulardii. “Sacc B” for short, this is actually a strain of yeast (not bacteria) that has shown some action against tough infections like Clostridia difficile (“C diff”), which has become antibiotic-resistant. C diff has become so resistant to antibiotics that the FDA even approved use of fecal transplants to fight it, so any tools to fight it are worth exploring. Sacc B has been shown to reduce symptoms of irritable bowel, inflammatory bowel, and even Candida infection. Sounds great, right?
But it can make your child feel sick and may trigger symptoms like diarrhea, nausea, bloating, picky appetite or rashes if you use it for too long (more than a month). If your child has antibody reactions to Candida or other Saccharomyces species, then using Sacc B may fail – because the body may attack the Sacc B with an immune response. Cross reaction can occur here, as Candida and Saccharomyces – though they are different species and strains – are all in the fungal family. And that can make Sacc B backfire for your child.
Solution? Withdraw the Sacc B if your child is feeling worse on it; or, don’t use it at all until you screen for antibodies (IgG/M/A) to Saccharomcyes cerevisaie and Candida species. You can also run a stool test for microbiology of these species, which should not be found in excess on your child’s sample.
If you use Sacc B, use it in short bursts, say 3 weeks at a time. Look for improvement then rotate off the Sacc B to mixed Lactobacillus and Bifido strain product, or a spore probiotic with Bacillus species. If no improvement, get professional guidance.
Another frequent fail in supplementing probiotics is using them when your child has small intestine bacterial overgrowth (SIBO) or small intestine fungal overgrowth (SIFO). Symptoms of SIBO and SIFO are similar to symptoms of other GI problems – which leads many parents to give probiotics a try. But, these can make SIBO or SIFO symptoms worse, and fast. A healthy small intestine (which is the first part of the intestine after the stomach) contains a lot fewer bacteria and microbes than the large intestine or colon (further down the pipe). Too much microbial action in the upper part feels awful. This is why kids with SIBO or SIFO often don’t like eating, are very picky, struggle with the slightest variations in food textures, or are even averse to feeding themselves. They may claim to be full when they’ve eaten very little. Add some multistrain probiotics, and this can make it all feel worse.
Solution: If your child is old enough to tolerate a SIBO breath test, you may wish to do this – but, I generally don’t use this test, because it is a tough test for a child to endure, especially if they do have SIBO! Your GI doctor may offer it, and you can ask about how to get your child through the test. If positive, you will need to address this before advancing a probiotic regimen. SIBO and SIFO can be helped with herbal supports and may not necessarily need antibiotic treatment. Once you do eradicate the SIBO or SIFO, single strain products at lower potencies can be helpful, such as Lactobacillus rhamnosus or reuteri at 20 billion CFU per day or less.
Now and then I’ll encounter a child who is downright over-dosed on probiotics by a well meaning parent. Many of us have felt enthusiastic about fermented foods like kombucha, sauerkraut, or kimchee, but overdoing it can create symptoms you’re trying to correct, like gas, bloating, pain, or food refusal. If you’re using these daily for your kids but they aren’t thriving with comfortable appetites and eliminations, revisit this strategy. I like to use a GI MAP PCR DNA stool screen as well as a stool microbiology test to look at what is going on. Sometimes a less aggressive strategy is better, and you can start by simply withdrawing fermented foods or probiotic supplements for a week or so, then resume at smaller doses. You may find your child simply doesn’t need so much probiotic supplementation, from any source.
Lastly, don’t confuse probiotics with pre-biotics. Pre-biotics are starches that friendly bacteria can ferment for us. Some kids (especially with FPIES) don’t tolerate pre-biotic supplements very well, because they may be high in FODMAPs. If you’ve chosen a product that has ingredients like inulin, chicory, galactic-oligosaccharides, cellulose, or maltodextrin, or if the label says “prebiotics”, take note – this may not be the one for your child. You can buy probiotics that omit these ingredients from brands like GutPro or Custom Probiotics.
The choices are dizzying in the world of probiotics, but the good news is there is probably a product that can help your child with appetite, eliminations, and more. If you’d like help, work with me to look deeper into what your child’s solutions might be.
Healing leaky gut is one of the most requested tasks in my pediatric nutrition practice. Many parents are surprised to hear me say that it is possible to repair leaky gut in children of all ages.
But what really works? There is a lot of buzz about dietary approaches, probiotics, and supplements, and less good research on leaky gut than we’d like, especially when it comes to infants, toddlers, kids, or teens. However, after twenty years in my clinical pediatric nutrition practice, I can tell you what nutrition supports I’ve seen consistently work, and what strategies often fail.
First, let’s get on the same page about what leaky gut is, and isn’t. It doesn’t mean there are actual ulcers or holes in your child’s intestine that are “leaking”. But it can mean that the intestinal wall has lost some integrity – and has become too permissive about the size of molecules that it lets pass into your bloodstream.
Another way you might hear leaky gut described is “intestinal permeability” or “hyper-permeability” – again, expressing a condition in which the intestine’s normally very selective, tight process for digesting and absorbing food has become, well, loose and sketchy!
Practitioners – myself included – might scrutinize zonulin, stool microbe studies (microbiology culture or PCR DNA methods), inflammatory markers like calprotectin, or immune markers like immunoglobulin A in a stool sample to gauge gut environment. Some doctors may order a lactulose-mannose test in which patients drink a concentrated solution made of those sugars. How these two sugars, which are different sizes, are excreted in urine can give a measure of how permeable the gut is. For more on intestinal permeability tests and their pros and cons, click here. Food allergy and non-IgE food reactions may also be measured, which requires a blood test.
Key To Restoring Leaky Gut Is….
Key to restoring a healthy gut is repairing “tight junctions” – these are the microscopic, traffic-cop structures of your gut. They form a tight seal between cells in the intestinal wall. When these junctions are injured, they break down – and larger-than-ideal molecules cross from the intestine into the bloodstream, triggering all sorts of reactions to stuff that your bloodstream and distant tissues were never meant to see in the first place. These might be anything from polypeptides (over-size fragments of food protein molecules that can masquerade as false hormones, false neurotransmitters, or invading antigens) to toxins, getting access your body from your gut, when they’re not supposed to. This permeability scenario is a catch-22, in that it can easily perpetuate itself, as more injury persists in the gut.
The intestine is our largest immune system interface with the world outside the body – so leaky gut can also wreak immune havoc, from autoimmune problems to frequent infections and illnesses.
What injures the gut? Lotsa stuff – and, making this harder is that leaky gut symptoms are often diffuse and insidious. They can evolve gradually, or with an abrupt onset that never quite resolves. Leaky gut can trigger symptoms in the GI tract of course, but also far from the gut, like headaches or joint aches, stiffness, pain, fatigue, or frequent colds and infections.
image courtesy Jill Carnahan MD
Here Are Usual Suspects for Triggering Leaky Gut
- antibiotic use
- intestinal Candida or other fungal species infections
- undiagnosed food allergy or food sensitivity
- intestinal flu or virus
- food poisoning
- non celiac gluten sensitivity
- poorly tolerated routine vaccinations
- chronic stress
- traumatic brain injury or concussion
- C section birth (baby misses exposure to helpful vaginal flora)
- mom treated with antibiotics in pregnancy or at delivery for any reason
- mastitis (mom needs antibiotics while breastfeeding)
- radiation therapy
- being underweight especially if you’re a baby, child, or teen
Most kids have had at least one of the items on this list. But that last one is key. In itself, underweight can cause intestinal permeability especially in children. You can address all the other triggers, but if your child is underweight – that is, more than fifteen percentile points off his or her expected pattern – your child’s gut can remain “leaky”. There simply isn’t enough raw material and energy on board for that tissue to repair itself, while your child is also trying to grow.
Here’s the rub: Generally, nobody scrutinizes your child’s growth pattern that closely (I will be honest and tell you that I even see gastroenterology work ups overlook this level of detail – and I routinely read my patients’ reports from their GI specialists nationwide). Without defining your child’s actual expected growth pattern – that is, where your child should be today given parental stature, pregnancy history, birth/delivery history, and growth history since birth – then you don’t know if your child is underweight or undernourished. You can learn more about that here.
I meet many children who are underweight. Sometimes it’s caused by families placing kids on diets that are too restrictive. Or some families have become so traumatized by frightening reactions to foods that they just don’t know how or what to feed their children – so, they don’t. Sometimes it’s caused by a well meaning practitioner who didn’t monitor growth and food intake, because they’re focused on lab tests and supplements instead, gave no guidance on what to actually eat, and encouraged a restrictive diet without effective replacements for foods taken out. I have also seen underweight caused by reflux medicines, which can diminish appetite and digestion when used for more than a few weeks or months. When it comes to picky eating, this too will drive growth status down in kids, injuring the gut too via underweight and poor diet.
The flip side of this coin is assessing what your child eats – how much and what – and the only way to discover if your child eats enough non-triggering, nourishing food is to assess a food diary (part of every new patient intake I do), and then align it with the growth assessment. The food your child eats is the lumber that will be used to do the gut repair – so it has to be the right stuff, in the right amount. Supplements (including glutamine, which is a helpful amino acid but not an energy source), herbs, and probiotics don’t provide this raw building material. I meet a lot of kids who have been given a lot of supplements, lab tests, antifungals, special diets, and measures to repair leaky gut. But they’re still struggling – because this essential growth and feeding part gets lost in the shuffle. But put the right feeding plan with the right supplemental supports, and boom – now you’re talking!
Here’s What Works to Repair Leaky Gut In Kids
- Balance gut microbe environment with herbal or prescription agents to directly address fungal burden, Clostridia burden (even commensal strains can be problematic if they far outnumber other helpful strains), Strep or Klebsiella, parasites, protozoans, and whatever comes up on testing. Combine this with probiotic supplementation that matches your child’s stool studies. My preferred tools for assessing this are GI MAP and Doctors Data Stool Microbiology.
- Customize the special diet to your child. Skip dogmatic, one-size-fits-all approaches.
- Give enough protein! Kids may need anywhere from 1 to 2 grams of protein per kilogram bodyweight per day depending on degree of growth impairment.
- Give the right protein; assess first which proteins are triggering with lab studies. Replace trigger proteins with equal or better value non-trigger protein sources, and keep them varied.
- Use free amino acids. Supplementing with amino acid mixes that give all 8 essential amino acids (and not just glutamine) has been a big bonus in my practice for kids who need deep gut repair. Formulas and powders are available. These give the gut direct access to building blocks for new tissue growth and repair. I use anywhere from 5 to 15 or even 30 grams daily of this protein source, depending on a child’s needs or status. Caveat: These won’t work well without an adequate total diet around them to support energy needs.
- Give enough total food including “clean” (non sugary) carbohydrates, which are crucial for growth in children (carbs preserve protein for structure and function, and keep it from being burned for energy) and ample healthy fats and oils. Kids can need 4-6x more calories per pound than adults, depending on age and growth status. Don’t feed them like little adults – give energy-dense, nutrient-rich food.
- Mastic gum, licorice root, zinc carnosine, glutathione, mineral-rich foods or products like Restore are just a tiny sliver of the thousands of products that can aid gut tissue repair. Work with a knowledgeable provider who has used these in children before. Using these tools is a routine part of my practice.
- Correct sleep pattern so your child can sleep deeply and wake rested. Sleep is when our organs are busy with repair and clean up. Hint: Children who are underfed tend to sleep poorly and wake more often.
- Minimize stress in your child’s world. Don’t discuss “leaky gut” with younger kids and don’t frame food or their bodies as problematic. Use positive language and emphasize the power to heal, which we all have.
- Give it time (like, months), be chill, and remember that your child’s body is a miraculous thing with its own innate drive to grow, repair, and heal.
And Now For The Leaky Gut Fails…
- Using rigid diet strategies for growing kids can be too restricting to support growth, gain, and gut repair. Yeast free diet, GAPS, ketogenic diet, AIP, SCD, Paleo, or Body Ecology all have merits (and devotees!), and I use components of all of them in my practice. But in themselves, none of these were created for use in children (except ketogenic diets for seizure control) and can fail when children are already struggling to gain or grow. If you’re not seeing good growth, gain, and progress in behavior or food reactions with one of these strategies within 2- 4 weeks, or if initial improvements lapse quickly, then it probably isn’t right for your child. Customize to your kid instead!
- Needing your child to like any of this, including taking supplements, having blood draws, or accepting different foods. You’re the adult. They’re not going to make it easy for you – that’s a given. Hint: Picky appetites can improve with addressing these three steps – don’t assume your child “won’t eat that”.
- Staying on reflux medicines for months at a time. These will work against your gut healing efforts by keeping pH in the stomach too weak to initiate good protein digestion. They will also cause your child to feel less hungry over time, to eat less, and to become more picky – thus leaving your child underfed and unreplenished for the task of gut repair. Learn more about the downside of reflux medicines here.
- Using glutamine, vitamins, minerals, or lots of supplements before you situate the right feeding strategy for your child. Feeding strategy means knowing what foods to use, how much and which sources of protein, fats, and carbs, and for how long, to support your child’s expected weight and height.
- Being aggressive with fermented foods, probiotics, or too much Saccharomyces boulardii. These can backfire if used for too long or at too high a dosage, and may even start to create their own dysbiosis or discomfort.
- Leaving fungal, parasite, SIBO or SIFO, or other dysbiosis untreated or under-treated. This can interrupt appetite, digestion, and stooling and keep tight junctions from sealing up.
- Giving up after 2-4 weeks. This is a restore and repair effort that may take months, depending on how long your child’s gut has been in the weeds.
Want help? This is a lot! Let me sort the best options for your child. Contact me today to set up a time to work with me remotely or in person. Or, peruse my options for books and on-line-course support.