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Is Your Child Underweight? Healthy Smoothie Alternatives To Pediasure, Ensure, Boost

Is Your Child Underweight? Healthy Smoothie Alternatives To Pediasure, Ensure, Boost

So your child is underweight, not eating well, not growing well. You’ve been told to give him calorie dense drinks like Ensure, Pediasure, or Boost; lots of butter, pudding, whole milk, and cream; and of course, lots of ice cream. Is this healthy?

Seeing these common recommendations is one of my least favorite findings as a dietitian in private practice working with kids. There are four problems here that can interfere with restoring your child’s robust health:

One, these drinks and foods are made with conventionally raised dairy products, which can contain bovine growth hormone, pesticides, traces of genetically modified feed corn proteins, and antibiotics, not to mention possible heavy metals from agricultural chemicals. All of these agricultural interventions have been linked to problems ranging from higher incidence of ADHD to earlier onset menses, other hormone disruptions in boys and girls, allergies, and neurological disorders.

Two, the child’s underweight status may be at least partly due to an undiagnosed milk protein intolerance or allergy – which irritates and inflames the gut, making nutrients and energy even harder to absorb. Be sure to get this sorted out before relying on any milk protein sources in your child’s diet.

Three, milk protein (casein) is often a constipating protein source, especially in children with some digestive insufficiency issues, like reflux or imbalanced gut microflora. Healthy gut microflora (bacteria) add enzymes to help us digest and absorb food, and keep bowel habits on track. If your child is unable to comfortably pass a soft formed stool most every day, then appetite can weaken – exacerbating the problem of packing in calories.

Last but not least – drinks like Ensure, Boost, and Pediasure rely on refined sugars and corn syrup (in various forms) to up their calories. I don’t like this because corn syrup is noted for containing a bit of mercury in every teaspoon, thanks to agricultural processing. Corn is also a genetically modified crop. Emerging research suggests that proteins in foods from genetically modified crops can trigger allergy. More allergy = more gut inflammation = more difficulty absorbing nutrients and energy = poor growth and gain. And, there is no sound argument for relying on refined sugars as a major strategy for growth and gain in children.

You can do way better.

First, make sure you are not battling undetected food sensitivities or food allergies. Get tested! You may need to avoid milk protein sources entirely, in order for your child to feel hungrier and digest more comfortably. Many labs and providers can assist with this, and this is a specialty in my practice too. Make sure you look deeper than just IgE allergy responses with a conventional MD allergist. For more information on this, see either of my books.

If eggs and nuts are allowable, get a powerful blender or food processor – the sky’s the limit, with those two ingredients adding creaminess without milk or ice cream. Everything on my list below is organic, no added sweeteners in the milk substitutes, and raw where possible. When using nuts, blend those first to smooth consistency with ice and a small amount of the recipe’s liquid. Then add remaining ingredients til smooth.

Banana Cream: ¼ cup raw cashews, 1/2 ripe banana, 1 cup almond milk, dash vanilla flavoring, 1/2 c crushed ice, 2 TBSP sesame tahini, 1/8 teaspoon stevia powder, hefty dash cinnamon. Add cacao nibs or if you don’t have those, organic mini dark chocolate chips (1 teaspoon) for additional zip. Blend ice, cashews, tahini, and 2-3 ounces of almond milk together first, until smooth and creamy. Add vanilla and remaining almond milk, and blend again til smooth. Add cacao nibs and blend to desired consistency.

Raw cashews, tahini, and banana with ice, almond milk, vanilla, and stevia make this smooth and creamy.

GI Soother: 2 peeled apples, 3 stalks celery with leaves, 5 mint leaves, 1/3 seeded peeled cucumber, 2 teaspoons ground flax seed or ½ teaspoon flax seed oil, ½ – ¾ cup white grape juice, 2 TBSP whole coconut milk, crushed ice

Not Latte:  1 cup organic brewed iced (decaf) coffee, 1 raw egg, 1/2 teaspoon maple syrup, 1 TBSP sesame tahini, 3 TBSP cashews, 3 ounces almond milk, 3 ounces whole unsweetened canned coconut milk, crushed ice

Power Peanut:    ½ soft ripe avocado, 1 TBSP cacao nibs, 1 TBSP hemp protein (such as Nutiva brand), 1 TBSP peanut butter, 3 ounces whole unsweetened canned coconut milk, 3 ounces almond or hemp milk, 1 teaspoon honey, crushed ice

Pineapple Smoothie: Fresh pineapple chunks ¼ cup, 1 ripe banana, 3 ounces whole coconut milk, 3 ounces unsweetened almond milk, dash vanilla, 2 teaspoons flax seed meal, 1 whole egg + 1 TBSP egg protein powder (option: try soaked hemp nuts in this one too)

These two are modified from a favorite book of mine called Raw Food Cleanse, which has several great recipes for smoothies, soups, and dips.

Soup Option, serve warm: ¼ cup raw cashews, 1 cup vegetable broth (such as Imagine brand organic), 6 stalks fresh young asparagus, 2 stalks celery with leaves, ¼ teaspoon fresh thyme leaves – blend all til smooth.

Pumpkin Navel:  ¼ cup raw pecans, 1 navel orange, ¼ teaspoon orange zest, ¼ cup pitted dates (soak these ahead of time to soften), dash vanilla, crushed ice, ½ cup almond milk, 2 TBSP cup cooked canned pumpkin puree, 1/2 teaspoon honey or dash stevia

Honeydew Lime Creamsicle: Click here for this really good smoothie – doubles as frozen pops in hot weather.

More ideas..

–       For any smoothie with fruits like kiwi, berries, papaya, peaches, pear, or mango, adding a raw egg or ground flax seed will create a creamy texture while adding healthy fats, protein, and minerals. Using egg protein powder is an option too. This will make your smoothies fluffy and creamy at the same time, but won’t add the fats you might like.

–       Raw nuts blend to a nice creamy consistency with the right tool – a powerful blender, Vitamix, or Bullet mixer. Soak raw nuts (and seeds) ahead of time if you like a more smooth, less grainy texture.

–       Hemp seeds, flax seeds, chia seeds, and cacao nibs are up and coming as alternative sources of protein, healthy fats and oils, and minerals. Add these to any smoothie to boost nutritional value along with calories.

–       Wean sugar-holics off their favorite processed calorie booster drinks by making your own without any added sugars: Instead of honey, maple syrup, or molasses, switch to an organic stevia powder, which is potently sweet at a tiny dose. One eighth teaspoon is enough to sweeten an 8 ounce blended drink. Add cinnamon in larger amounts – 1/4 to 1/2 teaspoon – to kick up the sweet and benefit from cinnamon’s blood sugar modulating effects.

–      Unconventional but healthy options for sweeteners in smoothies can create the creamy texture kids like, plus add extra fiber, vitamins, and minerals to smoothies. Try left over baked sweet potato (skins removed), cooked canned pumpkin, or leftover roasted mashed parsnips, which have a surprisingly pleasant and gentle sweetness when prepared this way (easy, fast, and good; use ghee, not butter, for extra sweetness and to avoid dairy protein).

–       Cook brown rice in whole coconut milk with honey, nutmeg, and cinnamon for an alternative to all the pudding your child may have been told to eat. Use a slow, low heat method and add almond or coconut milk to the liquid if needed during cooking. An hour or more of slow cooking may be needed.

–       Use coconut milk to make mild (but calorie laden) curry sauces that can go over favorite chicken or fish dishes.

–       A good blender or VitaMix will turn raw nut pieces into a creamy smoothie, but organic nut butters are an option if using whole raw nuts is too gritty a texture for your child.

–       Get the benefit of butter without the allergy or GMO hassle by using organic ghee (clarified butter). Pricey, but when you need it, you need it. Ghee has a sweeter taste than butter that isn’t clarified.

–       Skip the soy. Even if it isn’t genetically modified, it’s a frequent allergy offender, just like dairy protein. And there are endocrine effects from soy that are concerning enough for me to suggest that parents don’t use it as a major daily protein for a child. Translation: A serving here or there is fine, but don’t use it as your child’s protein source at every snack and meal daily. Soy protein is a common addition to bottled smoothies, energy bars, and protein powders.

–       If multiple allergies are in the picture – and nuts, eggs, and seeds are out – then work with a knowledgeable nutritionist who can assist with using essential amino acids, medium chain triglycerides, and safe oils to build smoothies around tolerated carbohydrate sources like ripe peaches, pears, avocado, plums, or winter squashes and pumpkin.

These options will give your child several nutrients, healthy fats, more protein, and calories to burn that are head and shoulders above some corn syrup, vitamins, and milk from a cow raised on chemicals. Remember that poor appetite and weak growth pattern can be signs of deeper problems with the GI tract, digestion, absorption, or inflammation. For strategies to sort these out, see either of my books, or get in touch. Troubleshooting growth pattern is one of my specialties in practice.

Q & A with Anne Dachel, Age of Autism on Special Needs Kids Go Pharm-Free

Anne Dachel, Age of Autism

Anne Dachel is a contributing editor for Age of Autism and parent of a child affected by autism. I’m grateful for her daily news alerts on all things autism and her tireless effort to advocate for autism awareness. When I sent her a copy of Special Needs Kids Go Pharm-Free, she wrote back “..my copy is now in tatters, having been carried with me in my purse everywhere I went so whenever I got a spare moment, I could read it.” Here are her questions for me about the book.

Your book gives dire statistics right at the beginning about the state of the health of American children. What has happened to children in this country during the last 25 years? Two major changes happened in the 1990s in the US, making American children born since then extremely vulnerable: One, the FDA permitted, with no safety review, the introduction of genetically modified (GMO) foods – including soy and corn, which both go into infant formulas and most processed foods. Two, we upped the vaccine schedule dramatically for infants and children. Both have shown potential to injure the human immune system, brain, gut or other organs‘ development and function, from birth onward. We’re just beginning to understand how detrimental this is for triggering asthma, allergies, inflammation, seizure disorders, autism, or gut/brain injuries that may mean poor outcomes like Crohn’s disease, eosinophilic esophagitis, learning disabilities and conduct disorders – all of which have risen dramatically in children since 1990.

Synergistic effects of GMO foods in pregnancy, in utero, in infancy – plus all the vaccines now recommended – are entirely unknown. For example: The gene inserted into GMO soy makes soy produce its own insecticide. It was found in gut bacteria of human volunteers eating GMO soy – meaning, the gene transcribed to the bacteria in the gut, and “taught” the volunteers’ gut bacteria to make insecticide. I believe this may be why some children with autism and GI problems are so treatment resistant, when it comes to correcting their bowel microflora. Do they have genes operating in there that make antibiotics and probiotics less effective? Nobody knows.
GMO crops are banned in most European countries. The approach there in the ’90s was that no data existed to show these foods were safe, so it was an unacceptable risk. The US approach was the opposite:The FDA said there no proof this is unsafe, so they allowed these highly profitable crops into the food supply. These can trigger allergies more often than their naturally occuring counterparts; other findings of detrimental effects on animals eating GMO feed crops are very disconcerting, from increased miscarriages and organ failures to death. Consumers are just beginning to understand this issue. Eating food that’s genetically modified to produce its own pesticide is something we wouldn’t want to do if given the choice, but Americans were not given the choice. Interestingly, the UK is also a GMO friendly nation, and has an even a higher rate of autism than the US.

Why aren’t doctors expressing alarm over what they’re seeing? Doctors are at a disadvantage for two reasons. One, they don’t study nutrition to a meaningful degree, and have a limited exposure to it. They are inundated with pharmaceutical information during their education and in practice, at the expense of valid information about nutrition or special diets. So, they don’t know how to assess kids for nutrition problems beyond the most obvious, and they don’t know how to provide nutrition care.  This leaves children unscreened and untreated; doctors may not even know there is potential for treatment here.

Two, they have no accountability for the injuries that may be caused by vaccines, due to the Vaccine Injury Compensation Program set up in the 1980s and the recent Supreme Court ruling that vaccines are “unavoidably unsafe”. Doctors have zero liability and zero accountability for vaccine injuries. If a child is injured by a vaccine, the doctor never gets sued; they suffer no penalty whatsoever. If a nurse goofs and gives a baby the wrong vaccine at the wrong time, and an injury occurs, there is no recourse at all other than to file a government claim and wait. My own family waited nine years for my son’s case to reach the docket, only to have it thrown out. I think this – along with how lucrative it is to vaccinate children in a pediatric practice – has kept doctors easy for industry to manipulate. This also leaves physicians free of any accountability to treatments for the injured – if they are brainwashed that these injuries aren’t happening, then there is nothing to treat. This leaves families scurrying for help elsewhere.

Your book is about nutritional needs…  What’s wrong with what we’re feeding out children? Lots can go wrong with how we feed our kids, even with all our best intentions. But the book is not about what parents are doing wrong, or even what is wrong with food. It’s about strategies that restore a child’s normal appetite, normal curiosity for a variety of foods that are healthful, normal bowel habits, and specific tools to replenish and support brain function with food and nutrients, instead of drugs, where ever possible.

Aren’t agencies like the Food and Drug Administration supposed to be making sure all our food is good for us?  What do you mean when you say the FDA is “overwhelmed”? The FDA’s focus has historically been about bacterial contaminants in food, not chemical toxins. There is less of a focus on agricultural chemicals, dyes, preservatives, additives, heavy metals, toxins, or colorings in food. There is no focus at all for monitoring the healthfulness of food, and certainly none at all for monitoring what GMO food does to human beings – the FDA has made it clear it doesn’t care about this with recent industry-friendly steps. It’s an overwhelming task to chase whether the food supply is safe, even in the FDA’s simplest terms; when you have beef in a single hamburger coming from dozens of cows raised in different countries, or juice in one carton from oranges in four countries, that’s a lot of processing over many locations to monitor. That’s just two foods. Parents can be a lot more pro-active than waiting to hear what’s okay to eat from the FDA. Buy organic foods if you can afford them; support your local farmer’s market it you have one; or even grow a few things yourself. This year I am working with an outfit called PersonalFamilyFamers.com to help us grow more of our own food this year.

What are sources we can trust for information on safe and beneficial foods and supplements? The organic label is one help. It’s not perfect, but hopefully your grocer is honest and sourcing with integrity. I encourage buying organic, and that includes meat and eggs as well as produce. Organic foods are non-GMO foods at least in intent; pollen from GMO crops can drift into organic crops, but there is no knowing for sure right now if this is happening. Knowing your growers and grocers is another step, and this is catching on more and more around the US. Use this map to find what’s in your area in this regard. As for supplements, Special Needs Kids Go Pharm-Free devotes a chapter to picking reputable supplements. These can be just as fraught with contaminants, unwanted metals or chemicals, and toxins as food can be.

What do you consider that most critical changes that need to be made? The biggest need I see is waking up the medical community on this. I would love to train pediatricians on the role of nutrition in conditions like adhd, autism, learning disabilities, conduct disorders, and depression/anxiety in children, and the potential for helping these children, without prescription drugs.  Right now the pediatric community seems to be asleep at the wheel. A generation of children has slipped through their fingers, fallen victim to chronic disabilities and diseases, and they aren’t doing anything about it. I include a chapter in the book on working with other providers, if you’ve become too frustrated with your pediatrician.

How can nutritional changes reduce the need for prescription drugs? Nutrition impacts learning, sleep, cognition, mood, behavior, and development in children. Most kids I encounter are not eating diets that support those in a normal fashion, and/or, they have problems absorbing their diets that no one has ever assessed or treated. You can’t fix nutrition problems with psychotropic medications, reflux meds, inhalers, or steroids…. You have to identify, sort and prioritize the nutrition puzzle pieces. It’s not unusual for parents to tell me after we’ve had a few months with nutrition care process that their child no longer needs a medication, is using less of it, or has found a totally different one that works much better. We remove the confounding of nutrition problems from the whole picture.

How can school lunches be made healthier? The short answer is money. Schools need money to procure healthy whole foods and prepare them on site, rather than buy packaged food prepared elsewhere that is laden with additives, sugar, salt, trans-fats, and GMO ingredients. Boulder Valley School District is extremely lucky to have professional chef and whole foods advocate Anne Cooper – aka “Renegade Lunch Lady” – directing our Nutrition Services. She has made incredible progress in reducing processed and sugary foods in our school lunches, and bringing in as much organic and locally sourced food as the district can afford – which is a big accomplishment in Colorado, a state that is notoriously weak for funding for education. Ann is a strong national advocate for healthy school lunches – rightly so, since ample data illustrate how crucial nutrition is to better student outcomes.

What is “Splash”? This is a medical food made for children with intestinal inflammation, Crohn’s disease, or multiple food protein allergy. The protein source in it is ready to absorb, that is, it is made up of individual amino acids, rather than whole or partial protein molecules that require some digestion. I first used it for children with autism in my practice about 12 years ago. It was clear that in some cases, it made a dramatic difference. I wanted to know if replenishing the brain with the amino acids would help them progress. The formula is not made for this purpose; it is made to avoid allergic reaction, and to help the gut wall heal. But children with autism may not digest proteins very well; besides causing allergy for some of them, I wondered if this could leave their brains bereft of neurotransmitter ingredients, which we get from proteins in our diets. I noticed that kids in my caseload whom I placed on special diets and who added this formula progressed more for language and reduction of autism features than kids who didn’t add the Splash formula. There is great potential here. Caveats too; the formula has some ingredients that I don’t like; but I do think a subset of kids can do well with this tool or a similar approach, no matter what the developmental diagnosis is, if there are certain deficits in their diets or GI function.

Can you describe some examples of improvements you’ve personally witnessed in children that you’ve worked with? First, kudos to these parents, because they were the boots on the ground. I do the work teasing out the problems and crafting the care plans, but the most success happens when the parents roll up their sleeves and work it. I have seen children move far away from an autism diagnosis; from needing an aide to not needing one; from facing a feeding tube and missing school due to physical weakness, to gaining weight and playing, learning, living again. I’ve seen kids leave behind debilitating eczema or asthma symptoms, and reverse poor growth and gain, after being told they were going to be stunted for life and need growth hormone injections. I have witnessed a teen who was suicidal, nearly non-verbal, constantly bullied, and disengaged while on SSRIs turn into a happy, talkative, engaged, and successful youngster without medications – by successful I mean getting a varsity letter on a sports team when engaging in sports prior to nutrition care was out of the question; getting a job; and making frinds.

What do our children need that they’re not getting from doctors? We need our doctors to stop regarding children with diarrhea, constipation, shiners, bloated bellies, chronic illness, frequent infections, anxiety, insomnia, and developmental disabilities as healthy enough. I would like to see doctors recover their curiosity: Why did they become doctors in the first place? Hopefully it was to do more than hand out prescriptions for Prevacid, Adderall, Amoxicillin, Miralax, and Albuterol, after jabbing a young patient with multiple vaccines at once. This isn’t health care; this is drug-pushing. It may be common now, but it isn’t normal for children to live on polypharmacy. And, though I have a masters degree in public health, I do not believe children need all the vaccines they now get. We have forgotten the role of nutrition in infection. It needs to be re-engaged. I do think we are over-vaccinating infants and children, and that it is causing more harm than good in the US at this point. The polypharmacy-and-hypervaccination approach hasn’t helped our kids, who are more chronically ill and disabled than ever before. We can’t slip into this as a New Normal. In fact, in Vaccine Epidemic, that is the dilemma I wrote about in my chapter.

Are your protocols strictly for “special needs” kids? Nope! I tried to convince my publisher to title the book differently to reflect that, but they felt parents weren’t ready to hear that this affects everybody’s kids. I don’t agree. I sense every week how frustrated parents are with what is happening to their children, and how they feel so unheard and unhelped by the medical community. Maybe in my next book!

Is Toxicity Overwhelming Our Kids? Make Sure Food and Supplements Are Helping, Not Hurting

Is Toxicity Overwhelming Our Kids? Make Sure Food and Supplements Are Helping, Not Hurting

In my pediatric nutrition practice, moms often ask: Is it worth it to spend the extra money on organic foods and pricier supplements brands? My opinion is yes. I often witness how children respond to different foods and supplements, to cheaper brands versus brands of supplements with stricter purity standards, to shifting from processed to more whole foods.

CNN recently reported on a study published in the journal Pediatrics about children with ADHD: They found that children with ADHD were twice as likely to have higher levels of a common pesticide than children who did not have ADHD.  In other words, pesticides commonly used on fruits and vegetables may contribute to ADHD prevalence in the US. Are chronic, small pesticide exposures enough to trigger ADHD in a child? Meanwhile, as any parent who has seen success with a Feingold diet knows, food colorings and preservatives of all sorts have long been suspected of triggering hyperactivity or other problems in children – see this list of 9 additives in particular that have been linked to ADHD.

That is one reason why I encourage families to buy organic foods when possible, even though they cost more. Buying locally from a trusted grower is even better – because you can actually visit or talk to that grower if you want, to see if their methods comply with organic guidelines. Another reason is because – back in 1988, when I was in graduate school – I wondered: Do organic foods have better nutrient profiles? It turns out they often do. Grain crops raised organically may have better amino acid profiles – which means that though they may have less total protein than a conventionally raised version, the protein is of better quality and more nutritious. Fruit crops show more vitamin C and antioxidants when raised organically.

Next on the list of much talked-about toxins are heavy metals like lead, mercury, arsenic, or hexavalent chromium. These are ubiquitous in our environment. Mercury now taints many foods we eat, from high fructose corn syrup to fish. One study found that a serving of high fructose corn syrup contained half a microgram of mercury (0.5 micrograms), and estimated a potential daily mercury intake from foods at about 28 micrograms for Americans. Children and teens may eat as many as 7 tablespoons of high fructose corn syrup daily, from soft drinks, condiments, processed foods, candy, and chewable supplements. This can mean a mercury exposure of about 10 micrograms daily, just from high fructose corn syrup.

By comparison, a flu shot contains about 25 micrograms mercury; and, the EPA guidelines suggest we limit mercury exposure to 0.1 microgram per kilogram body weight daily. For a 60 pound child, that means encountering less than 3 micrograms of mercury daily. For a pregnant woman, this may mean no more than 5 micrograms of mercury exposure daily. We haven’t even talked about coal burning power plants – another mercury source – and it’s easy to see that how easy it is to surpass mercury exposure limits, depending on what we eat.

Lately the CDC and American Academy of Pediatrics have had renewed interest in lead screening for children. Over the years, the level of lead in blood deemed acceptable by these agencies has repeatedly dropped – meaning, there is no safe level of exposure to this neurotoxin, second only to mercury on the list of heavy metals with potential for neurotoxic effects. Lead is a common contaminant in supplements. This is an especially big concern for children who have poor iron status, because those children will absorb more lead than kids in healthy iron status. These metals compete for absorption, and lead is readily taken up by the body in lieu of iron, when iron is not adequately situated in cells and tissues that need it. Lead exposures early on can permanently impair IQ and learning ability.

What about arsenic? From chickens and eggs to playground equipment, arsenic has been found in places our kids go and foods they eat. It may contaminate supplements too, along with pesticide residues and a form of chromium called hexavalent chromium, or Cr-6 for short. Chromium in its “trivalent” form is essential to humans – without it, we can’t regulate blood sugar normally. But in the hexavalent form, it’s highly toxic and known carcinogen, as anyone who has seen the movie Erin. A Consumer Labs review of some supplements found hexavalent chromium contaminants.

Just like the food industry, the supplement industry is challenging for the FDA to adequately monitor, and may not have purity guidelines as strict as parents would like. It often falls on the manufacturer to self-impose strong standards for a product’s purity and potency. But you do have the ultimate power, in your wallet. Buy only what you feel is best for your family’s health and well being. Compare purity standards among supplement manufacturers. If you’re not sure, ask for info from the manufacturer. If you’re not satisfied, move on. In Special Needs Kids Go Pharm-Free, I devote a chapter on “Know Before You Buy” to help families understand differences in purity standards for supplements. Now that I’m done giving you the bad news, here’s the good news on what you can do:

1 – Know your growers. Eat organic and locally sourced meats, eggs, dairy, fruits, and vegetables when possible, given your budget. Check LocalHarvest.org for an organic grower near you.

2 – Grow a garden this year. Start planning now for your kitchen garden, whether it’s herbs on your windowsill, cherry tomatoes in patio crocks, or more in a small patch in the yard. Easy crops for beginners are lettuce, pole beans, bell peppers, carrots, or herbs.  You’ll know exactly what you’re eating!

3 – When buying supplements, demand the best. Compare purity standards, which vary based on a manufacturer’s commitment to quality. For example, fish oils should be strictly mercury free; calcium supplements should be rigorously screened for lead and other contaminants; probiotics should guarantee potency; any supplement should be free of pesticide contaminants, and fillers with no function.

4 – And, just because a supplement is costlier, it may not be better. Ask the manufacturer what toxins they screen their products for, and how. Transparency is the key – if you are told this is proprietary, it may be wise to choose another product.

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

Orange Poop and Purple Crying: Halloween Colors Haunt Kids With Autism

Orange Poop and Purple Crying: Halloween Colors Haunt Kids With Autism

Orange and purple. Pumpkins, Frankenstein, cute goblins. It’s Halloween.  When I was a kid, October was my favorite month. Not only did it bring my birthday (still does), it felt like the most fun time of the year to me. Hurtling around outdoors with neighborhood friends on blustery, chilly fall days was my idea of heaven. We spent hours unsupervised and untracked, roaming woods and fields, and playing til our fingers were so cold it was just time to go in. New England’s blaze of colors was my backdrop. Leaf forts, leaf piles, leaf-filled scarecrows with my dad’s old clothes. Carving pumpkins, coloring decorations. Costumes, candy, staying out late to trick or treat.

It’s so different now, as kids spend less time outdoors with unstructured activities, and trick or treat traditions have faded out as we’ve become a more fearful society. Even less of this autumn joy might apply for kids with autism, sensory processing disorders, epilepsy and seizures – not to mention food allergies. It’s bad enough that this can be a traumatic week for kids on the autism spectrum and special needs. Routines and rules run amok (see Autism and Halloween: A Sometimes Scary Mix with Kim Stagliano). Behavior norms that parents work all year to teach their kids on the spectrum flip upside down. At Halloween, for some kids, confusion and anxiety mount as there are treats you can’t eat, and it’s loud, and random. But I’ve learned of news this week weirder than any Halloween trick, news that makes the autism journey at this time of year even stranger for me as a clinician.  It’s called Purple Crying.

The CDC and American Academy of Pediatrics are putting some spin together to convince new families, obstetrics nurses, and NICU staff nationwide that it’s normal to have a screaming, trembling newborn. And that colic is a “a normal developmental phase, not a medical condition”.  It actually says that on the Purple Crying website – yes, there is a Purple Crying Website.

Here we have a well funded effort afoot to systematically rework your thinking on this, right down to giving CDs about it to new parents, to take home with the new baby. The tag line on all this sends chills down my spine: “A new way to understand your baby’s crying”.

I did not understand my son’s crying as a neonate. Though the Purple Crying site does not intend to say purple babies are happy babies, my son’s crying turned him purple, and blue, and even left him unconscious for fleeting moments. It rocked his body into spasms. It kept him awake for as much as twenty straight hours, unhealthy and extremely costly for a newborn, who must eat and rest a lot, in order to survive. His limbs quivered, shook, and straightened. Yes, we called the doctor. Yes, we went to the emergency room. No, the physicians did not do anything. In fact, they were annoyed with us, because my son’s diagnostics were inconclusive. Once there were no clear test results, we went from being treated as proactive smart parents to being treated as nervous foolish parents. I should count my lucky stars: Nowadays, this scenario might land me in jail. I would be scrutinized for shaking him, in the absence of a clear cause for his symptoms. As it turned out, his symptoms were caused by an adverse event to newborn heptatitis B vaccine. But nobody told us that. We didn’t even know he’d been vaccinated in the nursery at birth. But that’s another story.

Prolonged, inconsolable screaming and crying is a serious sign of distress for an infant. It is a common feature of an adverse vaccine reaction. Is this what the purple crying public relations campaign is really about? CYA for the CDC? Like this: Your baby is suffering, maybe from a poorly tolerated vaccine we want you to use, so just ignore the crying, please.

Well, okay. Let’s acquiesce that babies can just plain cry their nuts off, boys and girls alike, for no particular reason, through the first three or five months of life, and it’s all right. Let’s make that leap of faith, and presume that we evolved to cry for no reason. We somehow got to the twenty first century, and never noticed this about human infants (but not other mammals?). Let’s presume screaming for hours on end is simply not related to a possible vaccine reaction (that may trigger lasting developmental effects, by the way), or any sort of painful inflammatory response to anything in shots or foods. Besides, the CDC reassures us that babies can look like they are in pain when they are screaming, but they’re not. Amazing creatures – they can do this for hours a day, and it’s fine. If you saw a newborn deer shrieking ceaselessly, would you think it was not in pain? Or that it was behaving “normally”?

I hate it when the CDC contradicts itself, and they’re doing it again. Here’s why this is not fine. First, obviously, it is not fine to tell parents to ignore possible signs of a vaccine adverse event. Second, for newborns, crying is exquisitely spendy. So is insomnia. It is not safe, normal, or healthy for young infants to spend hours awake and crying, week after week. Newborns are growing so fast, they need to eat two to three times more calories per pound than older kids and adults, just to stay alive. If you ate what a newborn needed, and you weighed 150 lbs, you would need to eat about 8500 calories/day just for baseline wellness. Add screaming all day and never sleeping to that, and, well, how long could you last? Just breathing inefficiently or suckling poorly can cost a newborn precious small gains in weight at the the start of life, if energy balance skews week after week into the red. This lowers nutrition status, and that in turn lowers disease resistance. Nutrition status directly correlates with immune function. Why is the CDC saying it’s okay for babies to endure something that threatens their ability to fight infection?

My next family arrives for consult in about thirty  minutes. Was their nine year old child one of the “purple criers”?  After taking nutrition histories on special needs children for eleven years, I have noticed that they usually are. They usually have more difficulty than their typical siblings did as infants, with screaming, crying, colic, and the orange part of this post: Explosive, copious, loose, orange-gold stools.  These often fill the baby’s diaper, pants, and shirt.  Stool to the neck and ankles, three or four, maybe even eight or nine times a day.  My pediatrician back in 1997 did not say it was normal for my son to have bowel movements like that. But he did tell me it was probably coming from my son’s diaper (no joke – see this memoir I published on this back in 2002). Here in my office, too many years later, pediatricians are still giving parents some peculiar feedback on this: Now it’s “toddler diarrhea”, and it’s “normal”.

No folks, purple crying and orange poop are not normal or benign.  My clinical observation is this: The more purple and orange there is in a child’s history from age 0-3, the more developmentally delayed, disabled, or challenged with inflammatory conditions the child is later on. These colors may haunt these kids for years, with lasting inflammation, developmental impacts, learning problems, or growth problems.

Colic is not a “developmental phase”.  Colic is often milk or soy protein intolerance, and it is painful. This pain is avoidable, much of the time. Food protein intolerance is not the only reason why an infant would cry, but it does account for a lot of colic in babies. It has been over-treated with reflux medications or drops to reduce gas. I give this topic a lot of ink in Special Needs Kids Go Pharm-Free, and in this blog too.  Please don’t start believing that in addition to regarding it as normal for your child to have crazy explosive poop several times a day, it’s normal for your baby to scream in pain for hours on end, months at a time.

When I was trained in public health nutrition and completing rotations as a dietitian, I never heard the phrase “toddler diarrhea”. It is now so common, no one blinks as children struggle through infancy and toddlerhood without potty training until they’re four years or older, stop growing as expected, or develop multiple food allergies and asthma. For kids with autism, it’s practically a rite of passage – often one that never ends: I have ten year olds with autism in my practice who can’t potty train, who struggle with impactions and constipation so bad they need regular hospital admissions for clean outs, and school aged kids with ADHD who can’t join sleepovers because they still wet the bed and have stooling accidents at school on a daily basis. Maybe the CDC will join up with the American Academy of Pediatrics to call this normal too. There will be a website, a CD from your pediatrician, a TV ad campaign. Followed by, no doubt, the drug of choice to fix it (mostly, it’s Miralax – another over-prescribed, non-FDA-approved-for-kids drug).

Here’s to young parents out there who are too smart to go there. Listen to your instincts and make safe choices around your child’s health care. Keep orange and purple for the fun parts of Halloween, not the horrors that can haunt your children for years.

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