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Gluten intolerance or low FODMAPs?

Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet.  This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.  

For years, this was hard to explain without a scientific explanation.   Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”.  Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unknowingly ingesting small amounts of gluten.  The results of this study described a condition termed, “Non-celiac gluten intolerance”.    It was after reading this landmark study that many physicians, including myself, began to validate parents’ concerns about gluten being the culprit behind their children’s gastrointestinal (GI) problems.

But then in 2013, just as word of non-celiac gluten intolerance was gaining popularity amongst physicians like me, the exact same group of researchers from Australia published a follow-up study on a similar set of about 3 dozen patients.  The findings of this 2nd study showed that instead...

Does your child have a food allergy or food sensitivity?

“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”

Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.

Parents considering these types of elimination diets need to be aware of a few key points:
The difference between “food allergy” and “food sensitivity”:

How to eat more vegetables

Did you know half of your plate should be from vegetables? Here are some ways to get more vegetables into your family’s meals and snacks.
 
1. Experiment with a new vegetable each week or each month!

Check out your local farmers market or produce aisle for something new and seasonal. Search the web or your favorite cook book for ideas on preparation, and don’t be afraid! Find recipes with some of your other favorite flavors or styles and you may just find your new favorite vegetable.

2. Get sneaky

  • Pureed peppers, zucchini or carrots can be “snuck” into tomato sauces for pasta or pizza. Not even the pickiest eater will notice!
  • Cauliflower, carrots or sweet potato can be steamed and pureed into mashed potatoes or a casserole.
  • Have a ...

New nutrition labels, same healthy eating advice

We all know that as a nation, we are getting bigger and heavier. Worse still, our future - our children- are becoming obese and unhealthy at increasingly younger ages. For decades, the scourge of obesity was blamed on a high calorie, high fat diet. Turns out, we have probably been doing it wrong all these years and our bulging waistline attests to this colossal failure. Research and the medical community now have increasing evidence that the real villain of the story is a very sweet little molecule called fructose. Fructose is what gives us the sweetness in table sugar (sucrose)…also in brown sugar, honey, agave, and of course, high fructose corn syrup. Call it by any name, but sugars are dangerous to our health. Fructose is addictive, much in the same way as alcohol and illicit drugs are. In fact, sugar (fructose) metabolism closely replicates alcohol metabolism except for the acute effects on brain. Sugar has been likened to alcohol without the buzz!

You may already have heard about First Lady Michelle Obama’s work with the FDA which has led to newly proposed changes to nutrition labels on packaged foods. The amount of sugars, specifically, “added sugars” will be part of that new label. I am not implying that a zero added sugar diet will be the panacea for the pandemic of obesity and ill health. We still need to eat healthy and exercise right. There is no magic pill, no startling new advice. Remember what our grandmothers used to say:
 

More tips for feeding picky eaters

In my last post, I shared a few tips about what to expect and how to help encourage your child to eat more. Here are some more tips to help your child eat more variety of foods, including more vegetables:

How can I get my child to eat more variety?

  • Offer a "nibble tray". At snack time, fill a muffin tin or ice cube tray with bite-sized portions of colorful, nutritious foods. Try cooked macaroni, cheese cubes, kidney beans, grape halves, broccoli florets, ready-to- eat cereal, and canned pineapple tidbits.
  • Let children cook. Your child is more likely to eat what he has helped to make.
  • Children can help wash vegetables, tear up lettuce, scrub potatoes, or stir batter.
  • Be playful. Call these finger foods playful names that a two-year-old can appreciate, such as: apple moons (thinly sliced), avocado boats (a quarter of an avocado), banana wheels, broccoli trees (steamed broccoli florets), carrot swords (cooked and thinly sliced), cheese building blocks, egg canoes (hard- boiled egg wedges), little O's (o-shaped cereal). "Olive or raspberry fingers" are much more appealing to be nibbled off their fingertips.
  • Serve new foods over and over again. A food not eaten at first may ...

Feeding Tips for Picky Eaters

It is important that children develop healthy eating habits early in life. Here are some ways to help your child eat well and to make meal times easier.

What to Expect:

  • After the first year of life, growth slows down, and your child's appetite may change.
  • It's normal for your child to eat more on some days and very little on other days.
  • A child may refuse to eat in order to have some control in his life.
  • A child may be happy to sit at the table for 15 to 20 minutes and no longer.
  • A child may want to eat the same food over and over again.

How can I encourage my child to eat more?

  • Set regular meal and snack times. Avoid feeding your child in between these times, so that they are hungry at meal and snack times. If you want your child to eat dinner at the same time you do, try to time his snack-meals so that they are at least two hours before dinner.
  • Limit juice and milk between meals. Offer water between meals, which will satisfy thirst without spoiling the appetite. Serve drinks at the end of the meal.
  • Respect tiny tummies. Keep portion sizes small. Here's a rule of thumb – or, rather, of hand. A young child's stomach is approximately the size of his fist. A good serving size for a young child is 1/2 slice of bread, 1 oz of meat, or 1/4 cup of fruit or vegetable pieces.
  • Respect changing appetites. Offer ...

Child’s Belly Discomfort Caused By Allergies

This is one of the most common questions that I get asked in the office. Allergic diseases are certainly becoming more and more prevalent in the developed world. General pediatricians and specialists are on ‘high-alert’ for this when evaluating a child that may be sick. Within the realm of intestinal diseases, however, a true allergy is actually not very common. To understand this, we must first understand what ‘allergy’ means.

An allergy is a biologic response from our body’s immune system. When our body senses a foreign invader, our army of immune cells attacks it. It does this by releasing chemicals into the blood stream and/or in to the organs where the threat may lie. Those chemicals are meant to destroy the invader, but often hurt our healthy organs as well. For example, airborn pollen may land in your eye, the immune system senses that pollen, releases those chemicals, and as a consequence we get itchy, puffy, watery eyes. The same thing can happen in the bowel if we ingest food that we are allergic to.

Intestinal manifestations of food allergies

One of the more common sites of an allergic response to food is in the esophagus—the food pipe. When the esophagus gets inflamed, it can manifest in a few different ways: heartburn symptoms, chest pain, chronic dry cough, upper abdominal pain, frequent regurgitation, or food that is stuck the chest. The name of this is Eosinophilic Esophagitis. Food allergies lower in the bowels can cause diarrhea, blood in the stool, abdominal pain, weight loss, anemia, and fatigue.

There are usually other red flags

One of the most important things to remember is ....

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