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Using Supplements Effectively: What Works, What Doesn’t

When do kids need supplements?

If you’re reading this, then you have probably already discovered, hopefully with some guidance from your team of health care providers, that your child has a nutrition problem. Or maybe you’ve come to suspect there’s a deficit for some nutrients in your child. Should you fix it with a supplement? Does that work? What’s the best way to use those?

These are important questions for children with special needs like diabetes, food allergies, asthma and inflammatory conditions, developmental concerns like Down’s syndrome or autism spectrum disorders, inherited metabolic disorders, seizures, or growth and feeding problems. As many as 60% of children with special needs have nutrition problems that can potentially impair their functioning, learning, growth, or development (1). It has been known for decades that keeping children well nourished, whether they have special needs or not, helps them reach their functional potential, by supporting learning, growth, and development.

Supplements may fit into this, and part of my job as a pediatric dietitian is figuring out if, when, and how they do. This is something to discern based on individualized nutrition assessment. I take into account several pieces: Medical history, signs and symptoms, a food diary, a child’s growth history, circumstances of the child’s gestational period, delivery, and early infancy, and so on. The last piece to fill in the blanks would be lab data, because lab data alone can’t describe a child’s nutrition status. Here are some tips to help you use supplements more effectively. More tips are in my book Special Needs Kids Eat Right (2009, Penguin/Perigee) which you can pick up in most bookstores or libraries, or order via your favorite on line bookseller.

– Kids need food! In fact, they need much more food per pound than adults. If an adult were to eat what a toddler needs per pound, that adult would need 8,000-10,000 calories per day just to maintain normal weight. Giving lots of supplements without enough food means your child will probably not be able to use those supplements as intended. So, before buying supplements, do the footwork to give your child adequate and nutritious foods. How to do this for picky eaters with special needs is covered in Special Needs Kids Eat Right.
– Supplements don’t fix problems caused by inadequate food intake in kids. Anxiety, insomnia, irritability, rage/reactivity, behavior, low muscle tone, fatigue, cognitive difficulties, frequency of infections or illnesses, and school performance are all affected by total food intakes in children. Give a balance of healthy fats and oils, clean carbohydrates that aren’t too sugary, and easy to digest proteins every day.
– If you’ve been given a list of supplements to buy based on lab results, beware. Giving a pill for each lab finding out of reference range is a cumbersome, ineffective strategy, in my experience. For nutrition interventions to work well, children need the right amount of food, foods they can digest well, and good digestion and absorption. Your provider can help you assess whether your child needs to repair digestion and absorption before giving supplements.
– Rule out bowel infections in your child with your health care provider before beginning a complex supplement regimen. Remember, whatever you feed your child will be eaten by his resident bowel bacteria first. New research is emerging to describe how important this bowel flora can be – from helping us prevent inflammatory conditions (2), to encoding our own GI tracts with the skill to make digestive enzymes (3). Other research shows that unhealthy bowel bacteria can impact behavior or even seizures in children (4, 5) – making it all the more crucial to balance this piece before using supplements that might “fertilize” the wrong bowel flora.

Those are just a few reasons why supplements need to be worked into a total care plan for your child, rather than given without thoughtful strategy. Work with your health care providers to get it right; given in the right total context, the right supplements can work very well for children. If you need more help and information, contact me or schedule an appointment at NutritionCare.net.

Citations

1. Nutrition In The Prevention and Treatment of Disease, 2nd ed. Ann Coulston and Carol Boushey, Eds. Elsevier Academic Press. Burlington, MA and London, UK: 2008

2. Maslowski KM et al. Regulation of inflammatory responses by gut microbiota and chemoattractant receptor GPR43. Nature 2009 Oct 29;461(7268):1282-6.

3. Hehemann JH et al. Transfer of carbohydrate-active enzymes from marine bacteria to Japanese gut microbiota Nature 2010 April 8;464 (7269):908-912

4. MacFabe DF et al. Neurobiological effects of intraventricular propionic acid in rats: Possible role of short chain fatty acids on the pathogenesis and characteristics of autism spectrum disorders Behavioural Brain Research 2007;176:149–169

5. Herawati R et al. Colony count candida albicans of stool in autism spectrum disorders. Clinical Pathology and Medical Laboratory, Airlangga University E-Journal 13(1):November-2006

Nutrition Solutions You Didn’t Know: Being A Pharm-Free Kid

[/caption]We’d all nod in agreement if asked, “…does nutrition matter for babies and kids? Is it important that they have enough to eat?  Does it make any difference what they eat?” I bet any pediatrician would too. So why don’t we tap that when it comes to helping special needs kids thrive to their potential? After all, these kids are at higher risk for nutrition problems than typical peers – problems that often go unnoticed, and have the power to impede progress.

We can, and this is what I have done in my pediatric nutrition practice for over ten years, working with kids who have asthma, severe food allergy, autism, Down’s syndrome, arthritis, growth failure, feeding problems, ADD or ADHD, clinical depression, and more. On top of that work, I’ve written Special Needs Kids Go Pharm-Free – because even after a decade working with kids, I am surprised that parents still have so little reliable information on how to leverage nutrition-focused tools for a child with a chronic condition or disability. Just as they can for any child, nutrition tweaks can make or break the difference between staying well or getting sick a lot, succeeding versus struggling at school, growing as expected or being stunted, and relying on symptoms-only drug treatments versus ditching the drugs altogether to feel and function even better.

Pharmaceuticals are not a bad thing. But our health care system may be stacked to make these too much of a good thing for our children.  For example, prescriptions to young children for stimulants (like Ritalin) and proton pump inhibitors (reflux medications) – just two types of drugs – have skyrocketed in recent years.  Children are now more medicated and more immunized than ever before – but are more chronically sick and disabled too.  Between 1980 and 2000, a 57% increase occurred in the rate of children with disabilities served by government programs.  In our public education system nationwide, about one fourth of learners are served under the Individuals with Disabilities Education Act (IDEA) – and the increase in number of children served under IDEA has grown at twice the rate of the general pediatric population.  In the same time frame that Americans have used more medications than ever, our overall health related quality of life has declined.

What this means is that our children have become more sick and disabled in the last thirty years, not healthier, and that prescribing more medications may not be helping. Physicians aren’t trained in non-pharmaceutical strategies for disease management in the US, as they are in several other developed countries.  Controversy continues regarding the influence the pharmaceutical industry may wield here on medical training, clinical trials, even medical journal publications – making good information on strategies like nutrition almost invisible.

Gluten free noodle bowl and gluten free pot stickers. No sweat.

I’m not sure how to eat these. Anybody? Beuller?Special Needs Kids Go Pharm-Free to the rescue. Affected children are often assumed to be presenting in a certain way because of the condition or disability itself, rather than because of a fixable, nutrition-related impairment.  Here are just a few examples of how nutrition can impact a child with a learning difference, developmental disability, or chronic condition. More examples with strategies to address them are found inSpecial Needs Kids Go Pharm-Free. These spotlight nutrition problems that have been linked in myriad clinical trials and public health data to learning deficits, growth or developmental impairments, insomnia, psychiatric disorders, or behavior problems in children; others abound in my case files:

–        Children with Down’s syndrome may have gluten sensitivity or celiac disease more often than typical peers. Even in the absence of celiac disease, untreated gluten sensitivity in itself may impede growth, stooling, and functional abilities for a child with Down’s syndrome.  A gluten free diet may help a Down’s child make unexpected leaps.

–        Over a third of boys with Asperger’s syndrome tend to be clinically underweight – that is, their body mass index (BMI) is <10th percentile.  This is a growth pattern deficit that may impair infection fighting, sleep, continence, and cognition.   The only correction: More food!  Healthy fats, easy to absorb proteins that are not inflammatory, good carbs – and plenty of them all.  In some cases, specialized formulas or custom made smoothies can help too.

–        In puberty, low BMI in boys is linked to low total cholesterol.  This is inversely related to testosterone level, meaning that testosterone will rise when cholesterol is too low. Low total cholesterol has been linked to psychiatric disorders, suicidality, and aggression.  Excess testosterone has been noted in about a third of boys and girls with autism; aggressive or obsessive compulsive behaviors showed improvement, in early work treating high testosterone with medication in these children.  Keeping a child’s BMI above 20th percentile, plus allowing ample daily healthy organic fats and oils, are nutrition measures that may help.

–        Any child with a self-limited diet (eats just a few foods) or mechanical problems with feeding (tube feeding, swallowing disorders, oral tactile defensiveness) can quickly become depleted for minerals like zinc, which allows normal appetite, growth, and immune function; magnesium, which helps nerve cell function; chromium, which helps control blood sugar; and selenium, a key antioxidant.  Children with Down’s syndrome in particular should be screened for zinc status.  While a high potency supplement can help, so can slow cooked stews and broths, chock full of vegetables and gluten free carbohydrates like quinoa (a grain that is also high in protein), black rice (higher in iron than regular rice), lima or kidney beans (to add zinc, protein, fiber) or breadfruit and potato (great for potassium).  Adding grass fed beef or free range poultry – organic if you can afford it – will further up the mineral, protein, fat, and calorie content of a crock pot meal.

–        Any child with a self limited diet or chronic inflammatory condition like cystic fibrosis, rheumatoid arthritis, Crohn’s disease, food allergies, or asthma may have sub-optimal iron status – which will make them more susceptible to infections, more cranky, hyper or irritable, less able to focus at school, and less likely to sleep well.  Entrenched iron deficiency (anemia) can leave your child tired, averse to exertion or typical play activities, showing shiners at eyes, and prone to eating non-food items.  Have your pediatrician screen serum iron, ferritin, transferrin, hemoglobin, and hematocrit.  If a supplement is needed, use one that is gentle and well absorbed, like ferrous bis glycinate instead of ferrous sulfate – but only with supervision, as iron quickly becomes toxic to children.

–        Copper is a metal we need in extremely small amounts, and a potent neurotoxin, if too much circulates in a free, unbound form.  High serum copper level has been linked to several psychiatric diagnoses.  Some children with autism may need treatment to reverse copper toxicity and should avoid copper in daily multivitamins; special formulations are available for this purpose.

–        Several studies have documented the presence of opiate-like polypeptides from poorly digested food proteins in autism; these have neurotransmitter effects that can impede language, pain tolerance, stooling, cognition, sleep, and behavior.  Special diets or digestive enzymes that target these proteins have shown promise.

–        Children with autism were found to have four or more GI issues, including histological changes, diarrhea, reflux, constipation, and abnormal endoscopies, about 40% of the time, compared to 5% of the time for their neurotypical siblings, in a study published in Pediatric Gastroenterology.  While some studies countered this finding, debate centers on methodology weaknesses in those studies that “bury” evidence of gastrointestinal problems in these children. In clinically standard nutrition screening in my own practice, I routinely find these problems in children with autism. If your child has a picky, weak, or rigid appetite, vomits undigested food, is dependent on medications for constipation or reflux, has undigested food in stool, can’t move bowels at least three times a week, has more than three loose or foul stools/day, or often presses his stomach on pillows, knees, or furniture for comfort – these signal atypical digestion and absorption that may mean lessened health or functional ability for your child. Several nutrition interventions may eradicate these uncomfortable symptoms and improve the flow of crucial nutrients to your child’s brain, muscles, bone, and organs.

–        Food allergies and sensitivities may go undetected in kids with Crohn’s disease, rheumatoid arthritis, autism, asthma, or other conditions.  Help can be had with correct screening for these, plus plug-ins of hypoallergenic formulas, special diets, or supplements to diminish inflammation.

–        Children with seizure disorders may improve with dietary measures beyond the traditional ketogenic diet.  Lessening inflammatory foods, avoiding neurotoxic trigger ingredients like glutamate, glutamine, phenols, or colorings, or treating undectected bowel infections for Candida or Clostridia are measures that have helped children in my practice with seizures.

Changing how your child eats, using a special diet, or adding targeted nutraceuticals may be a long term commitment for a person with a chronic condition or disability.  But it is a critically worthy one, if it means a child can improve beyond expectations, attend a regular school with no aide, avoid residential care or placement as an adult, have independence or have a job, and contribute to society in what ever way their unique talents and gifts allow.   I have witnessed all of these outcomes in persons with disabilities because of nutrition interventions.  This is not new, not novel, not even alternative – it’s simply engaging what we already know to be evidence-based in child nutrition. Any parent can start tapping these tools anytime, with Special Needs Kids Go Pharm-Free.