Nutrition Part 1--General Nutrition for Your Growing Children

NUTRITION PART 1 — GENERAL NUTRITIONFOR THE NEXT THREE EPISODES WE WILL TALK ABOUT NUTRITION.

IN THIS FIRST EPISODE WE WILL COVER GENERAL NUTRITION.  

WHY ARE NUTRITION DISCUSSIONS SO IMPORTANT IN YOUR PREVENTION DISCUSSIONS?

NUTRITION IS SO FOUNDATIONAL WHETHER YOU ARE HELPING CHILDREN TO THRIVE IN SCHOOL OR IN SPORTS OR TO COMBAT FATIGUE AND HEADACHES

WHAT ARE THE FACTORS THAT CONTRIBUTE TO LOW BLOOD SUGAR?

KIDS HAVE A NEED TO EAT MORE FREQUENTLY THAN ADULTS DUE TO THEIR FASTER METABOLISM

HOW DOES THAT WORK WITH KIDS AT SCHOOL?

IS IT UNHEALTHY TO SCHEDULE EATING VS. WAITING UNTIL A CHILD IS HUNGRY?

SO WE TALKED ABOUT THE TIMING OF EATING

LET’S TALK ABOUT HOW THE KIND OF FOOD MAKES A HUGE DIFFERENCE WITH THEIR PHYSIOLOGY

AND WHEN YOU ADDRESS LOW BLOOD SUGAR YOU ALWAYS COUPLE THAT WITH GOOD HYDRATION--WHAT IS A GOOD WATER GOAL?

DO PARENTS NEED TO BUY GATORADE OR OTHER FLAVORINGS?

AND MAYBE ONE MORE PLUG IN FOR ADEQUATE SLEEP

IS THIS A HARD ASK FOR SOMEONE TO COMMIT TO?

A LOT OF KIDS COME IN WITH CONCERNS FOR FATIGUE AND DIZZINESS AND STOMACHACHES AND HEADACHES AND THE MEDICAL WORK-UP FOR THIS LIST OF PROBLEMS IS MASSIVE.

WHY DOES FOOD MATTER?  WHY DOES NUTRITION MATTER?

AND THIS MAY MEAN SOME COMPROMISE ON FOOD CHOICES LIKE WE TALKED ABOUT WITH PICKY EATERS

WE SAY THIS OFTEN IN A COUPLE WAYS: PARENTS CHOOSE WHAT AND WHEN AND KIDS CHOOSE HOW MUCH;  OR, SAID ANOTHER WAY THAT PARENTS CHOOSE THE CHOICES

LET’S TALK ABOUT THE BROAD STROKES THAT WE CAN PAINT NUTRITION WITH.  WHAT IS ENERGY DENSITY AND NUTRITION DENSITY?

WHERE DO HIGHLY PROCESSED FOODS FIT INTO THIS DISCUSSION

WOULD YOU SAY THE SAME ABOUT ARTIFICIAL SWEETENERS?  

AND MAYBE JUST A QUICK BASIC COMMENT ON ENERGY CONTENT OF EACH TYPE OF FOOD:

IS THERE A PLACE FOR FOCUSING ON PLANT-BASED FOOD?

LET’S SPEND SOME TIME TALKING ABOUT SPECIFIC NUTRITION COMPONENTS WE NEED TO WORK ON.  THERE ARE SOME NUTRIENTS AND MICRONUTRIENTS THAT CAN BE CHALLENGES TO GET INTO KIDS.

FIBER FIRST.  WHAT IS IT GOOD FOR AND WHO IS AT RISK FOR DEFICIENCY?

HOW IMPORTANT IS IT THAT PARENT’S MODEL BEHAVIOR?

CALCIUM

AND IF THEY WON’T DO MILK.  CAN WE GET THIS ANY OTHER NATURAL WAY?

VITAMIN D—THIS HAPPENS NATURALLY WITH SUN EXPOSURE IS IT ENOUGH?

VITAMIN A

IRON

ZINC

WITH SUPPLEMENTS--WE ARE NOT TRYING TO REPLACE A WELL-BALANCED HEALTHY DIET, BUT SOME KIDS NEED THIS TO BE HEALTHY

LET’S TAKE THAT THOUGHT AND SEGUE TO OUR LAST SECTION ON HOW WE CAN HELP PARENTS ASSESS THEIR CHILD’S EATING.  WHERE DO WE START THE EVALUATION?

IS THERE A DANGER TO SCREENING AND CATALYZING EATING DISORDERS?

WHAT IS A 30,000 FOOT LEVEL VERSION OF HOW YOU WANT TO HELP PATIENTS?

HOW ARE YOU TRYING TO COME AT THIS FROM THE PATIENT / PARENT OWNERSHIP INSTEAD OF A RIGHTING REFLEX

PARENTS WORRY MOST ABOUT THINGS THAT ARE THE HARDEST TO CONTROL: TOILET TRAINING, SLEEP, AND EATING

PORTION SIZES WITH UPSIZING THINGS AT FAST FOOD PLACES AND ENCOURAGING KIDS TO EAT ALL THEIR FOOD

SO TRUSTING KIDS HUNGER AND FULLNESS CUES AND LET THE GROWTH CHART TELL THE TALE IS A KEY

RESOURCES:

FIRST IS THE Website: myplate.gov WHICH HAS SOME GOOD GENERAL FOOD PRINCIPLES

Deceptively Delicious BY JESSICA SEINFELD

Transcript

NUTRITION PART 1 — GENERAL NUTRITION

FOR THE NEXT THREE EPISODES WE WILL TALK ABOUT NUTRITION.

IN THIS FIRST EPISODE WE WILL COVER GENERAL NUTRITION.  THEN WE FOCUS THE NEXT TWO EPISODES ON NUTRITIONAL CHALLENGES

I am excited to talk about nutrition because Nutrition plays such an important role in helping children fulfill their potential AND it is an area that creates challenges for so many parents.

WHY ARE NUTRITION DISCUSSIONS SO IMPORTANT IN YOUR PREVENTION DISCUSSIONS

Nutrition really forms one of the three pillars of health, along with principles of sleep and hydration

NUTRITION IS SO FOUNDATIONAL WHETHER YOU ARE HELPING CHILDREN TO THRIVE IN SCHOOL OR IN SPORTS OR TO COMBAT FATIGUE AND HEADACHES

It is interesting that I have the same discussion whether I am helping a child to be on their A-game in school or working on debilitating fatigue and passing out in school.

WHAT DOES THAT FOUNDATIONAL DISCUSSION LOOK LIKE?  WHAT ARE THE PROBLEMS COMMON TO BOTH EVERYDAY SCHOOL SUCCESS AND THOSE IN NEED OF HELP?

So much depends on maintaining good fuel for our bodies.

Frequent contributor to the problem of focus in school or fatigue relates to low blood sugar

We need to improve blood sugar throughout the day by protecting against hypoglycemia (low blood sugar episodes)

Some are MORE PRONE to these episodes than others

WHAT ARE THE FACTORS THAT CONTRIBUTE TO LOW BLOOD SUGAR?

2 factors really:

Frequently happens when you go too long between eating, 

AND eating food that spikes blood sugar and then quickly bottoms out (processed foods)

KIDS HAVE A NEED TO EAT MORE FREQUENTLY THAN ADULTS DUE TO THEIR FASTER METABOLISM

Yes—I see kids who haven’t eaten within the last three hours show up with ketones in their urine—their 3 hours without eating is like my 18 hours without eating with their young metabolism. 

SO WHEN THEY SAY THEY ARE “STARVING” AFTER THREE HOURS THEY REALLY MEAN IT

Yes—some of these kids are literally losing weight after three hours—they become lethargic and cannot concentrate.

SO, GOING BACK TO THE HYPOGLYCEMIA FACTORS—HOW DO WE HELP THESE KIDS?—LET’S TALK ABOUT SCHEDULED EATING TIMES.  WHEN SHOULD CHILDREN BE EATING?

Eating time needs to be scripted—or at least the opportunity to eat needs to be planned—or more TACTICAL is the term I borrowed from Bluey where they talk about tactical Wee.

Eat every 2-3 hours (not ever longer than 3 hours).  This is 5-6 times/day.  HOBBIT or LOTR eating plan

First and Second Breakfast, etc.

Typical day may include eating at 07:00, 10:00, 1:00, 3:00, 6:00 then snack before bed

HOW DOES THAT WORK WITH KIDS AT SCHOOL?

It does take some coordinating with the teacher—but these teachers want what is best for the kids so I think it really just takes an ask.  I don’t want the child disrupting the class with eating but I also don’t want there to be a conflict between their health and the classroom flow

AND EATING A SNACK BEFORE THEY CAN GO TO RECESS WON’T WORK BECAUSE THE KIDS WANT TO GET OUT AND PLAY

Kids prioritize play over everything else which is great.  Best time is a natural transition time when the kids are moving anyway--and not before recess as you said, so maybe after recess or as they are moving to the library or computer lab.  Each teacher has a great script for the day and I recommend working with that structure.

I tell parents to let me know if they need a note for school to allow them to better fuel their children

IS IT UNHEALTHY TO SCHEDULE EATING VS. WAITING UNTIL A CHILD IS HUNGRY?

I believe that when a child admits hunger, they have been going for awhile and are losing weight.  Some kids are going 5 hours between breakfast and lunch.

Question is: should we schedule meals—VS decide from moment to moment “should I be eating right now” and do I even have access to food when I am hungry?

Healthy question: What is our motivation for eating? Emotion plays a role in what we eat

Is food a coping mechanism or a way to fuel our body? If we have a healthy view of food as fuel then appropriate scheduling and portion sizes are the right answer.

AND SNACKING ISN’T BAD?

Snacking is not bad in and of itself

We are not giving just anything for snacks—they are mini-meals

Not an excuse for junk

Snacks should be food—apple and peanut butter

Snacks sustain through BG dips throughout the day

Whole food carbs plus protein is a good combination

Planned, Sustaining quality snacks mean we won’t be starving and make impulsive eating decisions

SO WE TALKED ABOUT THE TIMING OF EATING—MAKING THAT PURPOSEFUL

LET’S TALK ABOUT HOW THE KIND OF FOOD MAKES A HUGE DIFFERENCE WITH THEIR PHYSIOLOGY

I often use an analogy familiar to anyone who has made a fire out camping.

The logs provide energy for a long time while pine needles flare up quickly and burn out quickly.

Food fuels our body the same.  We need to always include WHOLE FOODS and PROTEIN at these times to provide sustained energy

DO YOU FEEL LIKE KIDS WHO ARE OVERLY SKINNY MIGHT BE ALLOWED MORE ACCESS TO FOOD THAN KIDS WHO ARE NOT AS THIN?

I think there may be some judgments cast based on body shape, but these principles apply to all kids; and having meals and snacks (which are really just mini-meals) scheduled every 2-3 hours, let’s meal plan so they have healthier foods, have less hunger with less impulsive or binge behavior which leads to better food choices overall

AND WHEN YOU ADDRESS LOW BLOOD SUGAR YOU ALWAYS COUPLE THAT WITH GOOD HYDRATION

Yes.  When I talk about those who are not performing well I help them understand the important role of hydration in maintaining good blood volume to deliver energy and remove waste products.  This is especially important for those who have an positional dizziness—or dizziness on standing up.

WE ALL NEED MORE WATER THAN WE GET.  WHAT IS A GOOD WATER GOAL?

Hard to make a one size fits all goal based on age.

1 cup every hour or two for junior high and high school kids. 

1 cup every 2 hours for elementary kids 

For the older kids this gives you a range of about 64-128 oz/day EVERY DAY including weekends.  Kids doing sports and when it is hot need to be on the higher end of the range

Water needs to be in you.  You cannot hurry and hydrate before or during practices or games.

I joke in part with my athletes and kids who get dizzy on standing that if their urine isn’t clear enough that they could get away with not flushing the toilet after voiding then they need to be drinking more water.  Their urine should be THAT clear when they are optimally hydrated.

DO PARENTS NEED TO BUY GATORADE OR OTHER FLAVORINGS?

Try to stay with just low-cost tap water in water bottles they take to school.

AND MAYBE ONE MORE PLUG IN FOR ADEQUATE SLEEP

Sleep goal for the older kids of 8-10 hours/night based on whether they are still growing or have stopped growing.  Younger kids are pushing 12 hours/night

IS THIS A HARD ASK FOR SOMEONE TO COMMIT TO?

Yes.  I ask for a 1-2 week commitment: COMMIT TO THIS FOR 1-2 WEEKS TO GIVE IT A CHANCE.

This will give them enough time to feel a difference of moving toward better health.  If they feel the difference for themselves then they have a choice to be able to sustain it or not.

It’s like a lot of things—we know the answers on how to be our best self—we have to choose to do it.

I want them to have an experience, even for 1 week to know how good they can feel with enough sleep, food, and water and then it is their choice to follow for longer.

A LOT OF KIDS COME IN WITH CONCERNS FOR FATIGUE AND DIZZINESS AND STOMACHACHES AND HEADACHES AND THE MEDICAL WORK-UP FOR THIS LIST OF PROBLEMS IS MASSIVE.

Exactly.  When they are coming to me it is in large part for lab work or x-rays or interventions different from what they can do at home.  And that is totally appropriate.  

However, I like to start with the basic, functional interventions of optimizing health.  I like them to keep a 2-week prospective journal of symptoms to really hone in on the pattern to the problem vs trying to use their memory with a recall journal.  

And then I commit that I will use all of the resources from lab to medicine to imaging to specialist referrals to make sure we are getting the patient better.

WHY DOES FOOD MATTER?  WHY DOES NUTRITION MATTER?

Nutrition Affects quality of life—how they grow and develop for better for worse.

How they fuel their body.

These are the Legos they use to build the Lego Set of their body.

Inadequate nutrition will affect their growth and energy.

AND FOOD SHOULD BE SOMETHING WE ENJOY 

Yes, 

We should enjoy eating and especially together as a family.

This forms Habits that are the foundation of later health

Make eating a normal and pleasant part of everyday life

It shouldn’t  be hard and miserable

AND THIS MAY MEAN SOME COMPROMISE ON FOOD CHOICES LIKE WE TALKED ABOUT WITH PICKY EATERS

In broad terms I want kids to get the whole landscape of nutrition naturally as we continue to offer access to all foods without inviting conflict.  

We want all the vitamins and fiber and it may mean supplements are used as a safety net for many years.  

I recommend the Deceptively Delicious book to help with hiding healthy foods among other foods.  Work to offer fruit and vegetables every change possible.

WE SAY THIS OFTEN IN A COUPLE WAYS: PARENTS CHOOSE WHAT AND WHEN AND KIDS CHOOSE HOW MUCH;  OR, SAID ANOTHER WAY THAT PARENTS CHOOSE THE CHOICES

And I believe that when we do this, children are the beneficiaries of meal planning with optimal energy and nutrition density and there is less grazing on less healthy food

AND WE HAVE A LOT TO LEARN IN AMERICAN SOCIETY ABOUT PREPARING FOOD TOGETHER

You have a dear friend from Italy whose family spent days preparing food together for holiday meals—I wondered at the relationship building that happens during that time which then culminates in the holiday meal together.

There are so many Benefits of scheduled family meals

We want the whole experience with food to be positive from preparation to eating and we want food to be delicious Legos to build the coolest Lego set, the coolest body possible and this takes the right NUMBER of Legos and a GOOD VARIETY of Legos for parents and kids as the master builders.

LET’S TALK ABOUT THE BROAD STROKES THAT WE CAN PAINT NUTRITION WITH.  WHAT IS ENERGY DENSITY AND NUTRITION DENSITY?

Thankfully these terms are pretty self-explanatory:

Energy density—is the calories per amount of food AND

Nutrient density—refers to the vitamins and minerals per calorie

Energy density in particular affects weight—moving weight up or down based on how energy dense a food is

Nutrient density affects how well our body can perform it’s vital functions

Goal to find Food that affects calories and nutrition without going overboard

Famously, Michael Phelps needed 12,000 calories a day to not lose weight while training for the Olympics—we need to make adjustments based on our kiddos needs.

as an example: milk and soda may have the same ENERGY DENSITY but we need to consider the nutrient density OF THE TWO

Yes and we need to teach our kids but really we are teaching the family—as parents choose the choices

Nutritional issues never occur in isolation in a family

Success requires addressing the entire family

WHERE DO HIGHLY PROCESSED FOODS FIT INTO THIS DISCUSSION

We see that More processed foods equate to more weight and more health problems

In studies we see that with the same calories consumed patients gained more weight and had more health problems with processed foods

AND The more basic you go, the better it fits our bodies

The more processed you go, the worse it will affect our bodies

That is a great way to summarize processed vs. whole foods

WOULD YOU SAY THE SAME ABOUT ARTIFICIAL SWEETENERS?  ALSO PARENTS ARE HEARING THAT THESE CAN BE CANCER-CAUSING

Artificial sweeteners in and of themselves have not been found to cause cancer and we have used them a lot with our son who has diabetes.

Try to find natural sweeteners as much as possible

Learn to experience natural healthy choices

Consume artificial sweeteners in moderation if at all and be wise

AND MAYBE JUST A QUICK BASIC COMMENT ON ENERGY CONTENT OF EACH TYPE OF FOOD:

Yes, fat has twice the number of calories per gram compared to carbohydrates and protein.

AND we should mention that all fats are not created equal:

Yes, plant-based fats are much better quality fasts that animal-based fats

IS THERE A PLACE FOR FOCUSING ON PLANT-BASED FOOD?

I have recently become an advocate for plant-based diets

Plant-based diet; any movements away from the SAD (Standard American Diet) are beneficial—over time a goal to move away from inflammatory foods—egg yolks, cow milk and it’s products, red meat > chicken > fish, processed foods—

goal to spend most of our time in the plant-based and whole food space

Should be pleasurable

But, Per calorie, foods that come from plants are more nutrient dense

And when we are building this cool Lego tower we call a body—plant-based Legos equate with nutrition.  We needs vitamins and nutrition

We need a variety or there are things our bodies cannot do without supplementing

Per calories plant based food offers more variety than anything else

LET’S SPEND SOME TIME TALKING ABOUT SPECIFIC NUTRITION COMPONENTS WE NEED TO WORK ON.  THERE ARE SOME NUTRIENTS AND MICRONUTRIENTS THAT CAN BE CHALLENGES TO GET INTO KIDS.

FIBER FIRST.  WHAT IS IT GOOD FOR AND WHO IS AT RISK FOR DEFICIENCY?

Intestinal health

Constipation

Nourish micro biome 

Look at Fruit and vegetable intake—are kids getting them? When did they last have them?

AND WE CAN INCLUDE BEANS, LEGUMES, LENTILS AS PLANT-BASED SOURCES.  WHOLE GRAINS ARE HELPFUL.  QUINOA IS A GOOD ONE THAT CAN BE MIXED WITH MEAT AND HIDDEN.

HOW IMPORTANT IS IT THAT PARENT’S MODEL BEHAVIOR?

Very important to role-model intake by adults

Do you eat these things?

OKAY, CALCIUM.  SUPER IMPORTANT FOR LONG-TERM BONE HEALTH. HOW MUCH IS NEEDED AND HOW DO WE GET IT?

600 mg daily up to adolescence and then 1500 mg daily

1 serving of dairy has about 300 mg: 8 oz of milk, 1 regular yogurt, 2 pieces of string cheese

Goal of 2-5 servings daily based on age.

Can also do an equivalent of plant-based milks (check the label for amounts which vary by product)

AND IF THEY WON’T DO MILK.  CAN WE GET THIS ANY OTHER NATURAL WAY?

Not in any reasonable way.  Alternatives are doing a chewable supplements every day if they won't do milk or a alternative.  It takes about a full shopping bag of uncooked spinach to equal the calcium in 1 cup of milk.  Watch out for those who are trying to stay thin—milk is often one of the first calorie sources to be cut out.

VITAMIN D—THIS HAPPENS NATURALLY WITH SUN EXPOSURE IS IT ENOUGH?

Not in Utah—almost everyone is low during or after winter.  Please supplement this with a daily multivitamin.

VITAMIN A

In Fruits and vegetables 

Worry in those with restricted diets

IRON

We find this with kids not wanting to eat meat—which is one of the better sources

Supplement if not eating iron-rich foods.  Supplements don’t taste good but we can work at it.

As an aside, we test for this at 9-months of age or any time a parent is worried

ZINC

Important co-factor in our immune system and other functions

Similar to iron deficient kids

JUST TO RESTATE—YOU ARE OKAY WITH SUPPLEMENTS?

Yes.  They are a safety net.

They don’t need to be expensive.

Get what the family will use

Can be store brand

Can supplement vitamins through gummy or chewable, same with minerals we discussed.

Same with fiber like benefiber.

Some need Pediasure or similar to supplement calories.

WE ARE NOT TRYING TO REPLACE A WELL-BALANCED HEALTHY DIET, BUT SOME KIDS NEED THIS TO BE HEALTHY

Yes, there is an extra step and an expense for those without an optimal diet.

I think it helps a parent with their goal to nourish their child while not having fights over food and tears at each meal

LET’S TAKE THAT THOUGHT AND SEGUE TO OUR LAST SECTION ON HOW WE CAN HELP PARENTS ASSESS THEIR CHILD’S EATING.  WHERE DO WE START THE EVALUATION?

Start with a Dietary history

What a typical day looks like—are they skipping meals, how is their food variety, are they getting all the food groups, what are they drinking?

Are there any obvious Deficits?  Are they missing anything major?

SO THAT IS THEIR INTAKE, WHAT ABOUT A CHILD’S OUTPUT?

How much are they moving? Are they moving more than they are taking in?

Enough food, hydration to make up for movement

Michael Phelps analogy

Match their activity with their intake

THEN HOW DO THEY COMBINE THAT INFORMATION FROM HOME WITH THEIR WELL CHECKS?

At well checks, We are good at measuring compared to a growth chart and compared to themselves.

Growth charts very helpful

Look at growth—is weight gain adequate / too much / not enough

Nutrition focused physical exam—paleness, recurrent illnesses, nail, skin and hair quality

Are there signs of problems with nutrition

For example: Constipation—lacking fiber

IS THERE A DANGER TO SCREENING AND CATALYZING EATING DISORDERS?

Screening—careful with eating disorder population

WE ARE GOING TO TALK IN THE NEXT TWO SESSIONS ABOUT GENERAL PRINCIPLES TO HELP, BUT WHAT IS A 30,000 FOOT LEVEL VERSION OF HOW YOU WANT TO HELP PATIENTS?

First off—full disclosure—Everyday I listen to people to try to give them a diagnosis, a solution, to give someone the right answer—this is my reflex.  With nutrition I need to get away from what I learned is called—a righting reflex—a reflex to right the problem.

HOW ARE YOU TRYING TO COME AT THIS FROM THE PATIENT / PARENT OWNERSHIP INSTEAD OF A RIGHTING REFLEX

In this situation in particular, I want to:

Gain their understanding—what do they see as a solution?

What can they change?  What are they willing to change?

INVITING CHANGE CAN BE DAUNTING

We are looking for Small changes vs changing everything all at once—can be overwhelming

Parents want to do what is best for their children BUT LIFE GETS IN THE WAY

Better to build on small habits sequentially.

A solution Needs to work for them

AND PARENTS WORRY MOST ABOUT THINGS THAT ARE THE HARDEST TO CONTROL: TOILET TRAINING, SLEEP, AND EATING

So, to help with this some open-ended questions are good:

Asking how people eat.

Asking about portion control teaching

Asking about hunger and fullness cues that the kids have

AS ADULTS WE ARE GOOD AT MESSING UP PORTION SIZES WITH UPSIZING THINGS AT FAST FOOD PLACES AND ENCOURAGING KIDS TO EAT ALL THEIR FOOD

And with these processed foods and sugary cereals many of these foods don’t fulfill nutrition goals so your body thinks it needs to eat more

Think about Pica—kids are eating dirt—because their body needs more iron.  Body isn’t sure what to do, just that it needs more of something to fix a deficit—maybe dirt will help?  Crazy but it’s how a body works.

SO TRUSTING KIDS HUNGER AND FULLNESS CUES AND LET THE GROWTH CHART TELL THE TALE IS A KEY

Yes, and then we can make adjustments if any concerns arise.

Important to note that even from infancy growth hormone will drive increased intake during times of growth spurts and then they will drop back down at times when they are not growing as much—parents get concerned when appetite goes up and down but this can be natural and normal

GREAT DISCUSSION!  

TO FINISH WE WILL INCLUDE A COUPLE RESOURCES

FIRST IS THE Website: myplate.gov WHICH HAS SOME GOOD GENERAL FOOD PRINCIPLES

AND THE BOOK

Deceptively Delicious BY JESSICA SEINFELD

Jerry Seinfeld’s wife—but it isn’t as funny as he is.