Fire crests Bear Peak behind Boulder's Flatirons, just a mile or two from my house

What a horrific year for Colorado. My family was among those evacuated due to fire (click here for an amazing time lapse video of the first 36 hours of this fire). As of this moment, I am back in my home. But while my neighborhood was blessed with weather breaks and well timed rain that helped crush the Flagstaff Fire (still only 40% contained at the moment, but prognosis is good), thousands are displaced from their homes all over the state. And no doubt, a number of those are families affected by autism.

Evacuating sucks. We had our check list. But when it comes down to watching smoke and flames billowing in your neighborhood, it’s still pell mell. While my husband hurried home from work, I went through the motions: Vital records. Passports. Mortgage documents. Tax records. Photo albums (all of them? some of them? what about the hundreds of photos in boxes in the basement?). Health records. Check book (who uses those anymore?). Computers. Phones. Et cetera, et cetera. But I didn’t have boxes for any of this stuff. Into plastic garbage bags it went, which doesn’t help once at the destination – pawing through trash that isn’t yet trash is what this becomes. Then onto food, medications, supplements that might be needed. Again, what do I put all this in? How do I organize it at my destination? How many days’ clothing? Then cats. Two cats, one carrier. Oops. On and on. Anxiety froze my teen son while I scurried around, but after some prompts, he earnestly set about packing things dear to his heart: Model trains he painstakingly rebuilt, airbrushed, painted, and customized; a ceramic creation from school; some of his paintings and art work; a rosary given to him by his grandparents.

This is where it can become a totally different journey. Persons along the autism spectrum of any age – young child, school age, teen or adult – are likely to suffer much more anxiety or emotional reactivity than others in a fire evacuation – which is among the most anxiety provoking things imaginable. Routines and sameness become even more essential. We were fortunate to have a friend out of harm’s way but not too far from our home, with a big house, who was out of town and opened her home to us. When we arrived, we were free to cook our dinner and tend to our needs without interruption. It was as smooth a transition as could be hoped, and we were able to return home in about thirty hours. But how many families are not so lucky? Settled at our own dinner table this evening, with deep gratitude, we all thought about  ways to help evacuee families affected by autism. Here’s our list:

DO’s:

- Ask what routines are most essential to this family or to the affected person’s well being. Respectfully allow those as possible, without judgment.

- Make grocery trips for needed foods, rather than assuming evacuees are up to the shop. After running laps in and out of the house to load a car, heading to the supermarket for forgotten essentials is the last thing a tired and stressed family needs.

- Buy exactly what is requested for foods, right down to brand preferences. People on the autism spectrum can have rigid food preferences and routines, while others use restricted diets essential to their functional ability. Varying off the food part of the routine can be extremely disruptive for a person with autism, or even akin to going off medication if they are using a special diet.

- Expect odd behavior as this person may work hard to manage escalated anxiety. My son’s suggestion: “Let them open and close doors, switch lights on and off, play with the vacuum cleaner, or whatever their obsession is, let them do it. They will need to focus a lot on it to stay calm.” I can go with this, within safe parameters.

- Think cats: When stressed, they retreat, and like to hide in small spaces. This can be true of youngsters with autism too. Create a separate space suited to the age – a big appliance box with pillows, a play tent, a small quiet room that can be closed off for reading, watching a DVD, or playing a computer game. Let the person with autism have this space if need be. Don’t insist that they socialize with your children or with anybody for that matter. They may be too overwhelmed, and unable to express that.

- Consider that loud and chaotic activity may be overload that leads to total meltdown for a person with autism. While typical kids might welcome a loud boisterous game or lots of giggling and squealing with the Wii as a distraction, these can push a child with autism over the falls. Check in with the evacuee family on tolerable noise levels for things like music, TV, how to best mix with other kids in the house, barking dogs, or kitchen noise. Help strategize ways to allow the person with autism to buffer that if need be.

- Support vigilance for the whereabouts of a child, teen, or adult with autism at all times. In a new and overwhelming setting, elopement or fleeing is common, and obviously dangerous. If you have a pool or are near water, this is paramount: Drowning is the top cause of death for children with autism.

DON’Ts:

- Don’t assume evacuees are at ease leaving an affected child in your hands, and don’t be offended if they aren’t. Do the errands for them instead, and let them comfort their loved one with autism in the new setting.

- An anxious child with autism is probably going to behave in disruptive and annoying ways, or may remain inconsolable and terror stricken. Don’t judge or offer parenting advice. Period. Instead, when you have time, read up on this parenting journey with authors like Tony Attwood or Patricia Bashe and Barbara Kirby.

- Don’t introduce pets to a child on the spectrum without first checking with the evacuee family on what is best. Some persons with autism adore dogs and other animals, while some are extremely anxious around them. Some with autism intuit how to handle and behave around pets while others may not. One affected child I met was delighted with a friend’s cat, but did not differentiate this from roughhousing with a dog or stuffed animal; luckily we separated the two before either was injured.

- Don’t talk about the affected person’s condition (child, teen, or adult) in front of them or assume they don’t understand you.

- Don’t give the affected person information about the fire, their home, or circumstances without first vetting protocol for this with the family. Don’t discuss details of the emergency that caused evacuation in earshot of the affected person with an assumption that they are not listening or understanding you. They may be acutely aware of and understanding what you are saying.

While many kids may regard being welcomed into a friend’s home in a crisis as a sleepover adventure, it may feel like a foreign and frightening land to a child with autism. Sensitivity to this difference can make all the difference for an evacuee family. For more information on how to help evacuees, visit HelpColoradoNow.org. My thanks go out to the incredible fire fighters who are up on Bear Mountain in the dark as I write this, and will be up there all night, defending our safety just a couple thousand feet below.

- B6 is a vitamin – which means, we need to eat it. We can’t make our own supply. It has various metabolic forms that our body uses, including pyridoxal-5-phosphate (P5P), another popular supplement. Among its many jobs is supporting production of neurotransmitters like dopamine and serotonin – both of which have shown altered status in persons with autism.

- There is a long pedigree for B6’s success in treating seizures; about a third of persons with autism have seizure disorders. Deficiency of this vitamin can cause seizures or other neurological symptoms.

- There is also a long pedigree for using vitamin B6 therapeutically for psychiatric disorders, like schizophrenia, along with other nutrients.

- B6 is a water soluble vitamin, which means the body doesn’t store it. Whatever is not used is excreted in urine, usually within hours. If you’ve ever noticed bright yellow urine after taking a multivitamin with extra B6 in it, you are likely seeing some of this in your toilet!

- Bernard Rimland PhD, founder of the Autism Society of America and the Autism Research Institute, pioneered the use of B vitamins in the 1960s for his own son, who was affected by autism.

- B6 has low toxicity, with a good track record of being safe to use. High doses are usually well tolerated, with any side effects resolving once it is stopped.

So should your child supplement it? Will it help autism features? As always, the best strategy is to ask an experienced and licensed health care provider to help you assess your child’s total nutrition needs. B vitamins work en suite – together – with other nutrients and with food to support brain chemistry, extract energy from food, and help nerve impulse transmission. Giving just B6 alone in a high dose – without other B vitamins, magnesium, or adequate diet – may fail to produce any results. That said, it’s one of the safest nutrients to supplement. Here’s the scoop on B6 and autism:

- Children with autism may well need higher doses of vitamin B6 than healthy typical peers, for many reasons: Picky diets that lack vitamins, gut inflammation that impedes absorption of B vitamins, or gut microbial infections that eat up B vitamins before your child can absorb them. Mitochondrial disorders (inherited or acquired) can trigger higher need for B’s too, as can an inability (inherited or acquired) to convert B6 to its active form in cells. One study noted that indeed, children with autism had high levels of B6 but low levels of its metabolically active form P5P. This would mean that dozens of enzyme actions needed to balance neurotransmitters in the brain would not function to potential.

- A number of studies testing high dose B6 have showed benefits. In a survey of 7256 parents, 49% reported symptoms of autism improved in their children with B6 and magnesium supplement.

Where to start? Begin with a high purity, high potency multivitamin and mineral supplement for your child. Reputable brands are Kirkman Labs, ProThera, Pure Encapsulations, and many others. You can browse products I choose in my practice, in the NutritionCare.net virtual dispensary (use access code MyNCFC and PW 80303 – my office zip code – to set up your own account and start browsing.)

1) Decide on the format your child can accept: Liquid, powder, capsules, or chewables.

2) Choose a product that provides the entire B group of vitamins (B1, B2, B6, niacin, folic acid or folacin, B12 as a blend of methyl and cyanocobalamin, pantothenic acid, biotin) at potencies of at least 100% of daily recommended value.  Make sure that this product also contains magnesium to at least 100 mg; more may be preferable. Some multi’s add P5P, such as Kirkman’s Spectrum Complete and Klaire Labs VitaSpectrum.

3) Let your child trial this multivitamin and mineral daily for 2 weeks, withdrawing if you note reactions or side effects.

4) Once it’s clear that your child is tolerating this well, consider adding a product that adds more P5P and magnesium, such as P5P with Magnesium from Klaire Labs or Kirkman Labs.

5) Give the additional P5P early in the day with the multi, not toward evening, as B vitamins are usually energizing and may keep kids awake if taken too late. A reasonable starting dose is 5 mg P5P for a 30 pound child; older children may benefit from 25mg P5P, which is well above usual intakes from food or ordinary supplements, but possibly beneficial for those with metabolic disorders that prevent conversion of B6 to P5P in the body.

6) Continue if you note benefits. Reported benefits include improved communication, less stereotypical behavior, less sound sensitivity, improved expressive language, improved attention, and less hyperactivity.

Caveat:  Some children become hyper and agitated when given very high doses of P5P. Start low and go slow; withdraw if you see worsening hyperactivity. Your child may do fine on a lower dose, or may benefit from B6 more after treating bowel infections for yeast and other microbes (which also use B vitamins).

B6 is a promising, easy-to-test option for any child on the autism spectrum. Get input from parents who have succeeded and from your child’s health care team. If your child is using medications, it’s especially important to check with your doctor and pharmacist about drug-nutrient interactions.

No GMOs, pesticides, additives, or other junk please

When parents hear “nutrition matters for baby” or “kids need a good breakfast”, what does that really mean? There are plenty of vague platitudes out there filling parenting web and print media, cereal box side panels, and TV ads. But how important is this, really?

Even before pregnancy, what we moms eat and what toxins we are exposed to affect our unborn children. Whole foods organically grown in healthy toxin free soil without genetically modified seeds or feed grains will safely nourish you and your kids – and it really does matter. For example:

-  Vitamin D status before and during pregnancy may affect growth of the fetus, length of pregnancy, and immune function for baby after birth. Babies may be at more for risk intrauterine growth retardation in moms who are vitamin D deficient. Even adult outcomes for mental illnesses may be impacted by mom’s vitamin D status during pregnancy.

- Ideal iron status – not too much, or too little – is crucial for normal fetal development. Iron can cause lasting damage to fetal organs and brain tissue, if the wrong amount is on board.

- Toxic exposures for you now may influence whether your grandchildren get cancer.

- Ultrasounds may damage DNA expression in your baby’s brain. Limiting exposure to these while pregnant may be safest.

- Missing folic acid, a single simple nutrient, can have catastrophic outcomes for baby. Taking it before you conceive may prevent birth defects.

- Unvaccinated babies have fewer allergies, ADHD, and chronic disease than vaccinated children. Toxins in vaccines along with early and aggressive exposure to injected antigens may be making our children more chronically ill. This bolsters the need for strong nutrition to support strong immune response. Even vaccinations taken by mom prior to pregnancy may have a negative impact too.

- Breastfeeding is as or even more powerful than vaccination at preventing infectious diseases – so powerful in fact, that the CDC has promoted cessation of breastfeeding to keep natural antibodies from negating those in vaccines! Score another point here for nutrition solutions over pharmaceutical ones.

- Genetically modified organisms in food crops (GMO) are linked to increased allergies and organ damage. These foods are unlabeled in the US – so that means you’re probably feeding them to your family. Look for foods that tell you they contain no GMO ingredients. Livestock and farm raised salmon are typically fed GMO corn. Splurge on organic meats to avoid this when you can.

These are just a few bullets from the staggering amount of information on nutrigenomics – that is, how nutrients (and toxins) impact gene expression and outcomes for our babies. But one fact is too often overlooked for parents nowadays: Nutrition really matters, and it’s up to us to engage it. Your child’s immune system depends on a steady flow of toxin-free nutrients and foods, and a well functioning digestive tract, in order to mount a vigorous response to fight infection. Your child’s brain needs the same, to grow and function to potential. Nutrition is an ensemble piece if there ever was one. Nutrients and foods work together, relying on each other in cells and processes in the body, to create a hale and hearty human. No pharmaceuticals – vaccines included – do these jobs. Food and nutrients do this.

Despite this old wisdom – documented by decades of nutrition science and practice – pediatrics today pays little due to helping parents build kids’ nutrition. Nutrition studies are not part of your pediatrician’s training. Emphasis is heavy on pharmaceuticals, a shift that has happened in the last generation. As a child, I visited the pediatrician very rarely; I have not a single memory of me or any of my four siblings going to the doctor with an illness. We each passed through the rites of chickenpox, mumps, and measles; we never got ear infections; we very rarely got colds or flu. My friends came from families of three, five, or even six or seven children. I knew no one with asthma, allergies, diabetes, epilepsy, or other conditions or disabilities. With all the pharmaceuticals now given to children beginning from birth, we must ask if these are making kids less well, and more debilitated. Over half of US children now have a chronic disease or disability – obviously, using more pharmaceuticals has not improved health for our children.

Pay as much attention as you can to real food for your family. Cooking from scratch is a lot of work, but start – somewhere. Even a few more whole food meals or snacks a week will give your kids fewer toxins, more minerals, varied protein, and essential fats and oils – all key for brain and immune function. Even busy families can begin with these ideas:

-       Trade processed fortified breakfast cereals (infamous for delivering too much corn syrup, sugar, additives, or even too much iron for some children) for whole grain oatmeal, eggs, or additive-free organic breakfast meats

-       If cereal is non-negotiable, transition to organic brands that use whole grains. Add raw nuts and seeds like cashew, sunflower, or pumpkin seeds.

-       Once a week, try a session with your kids of making your own cereal. Use whole oats, nuts, seeds, cinnamon, honey – any granola recipe can do.

-       Trade sugary GMO concoctions like Ensure, Pediasure, or Carnation Instant Breakfast for power shakes made from organic almond, hemp, or coconut milk; add whey powder, nut butters like tahini, honey, and ripe banana. Let your kids experiment with ingredients, within your parameters of fruits, seeds, nut butters, cacao nibs.

-       Stuck on Cheezits and Goldfish crackers? Rotate in crunchy nut and seed mixes, Justin’s Nut Butters, raw young asparagus, or crisp bell peppers. Add dips like guacamole or hummus. If all else fails, offer nut butters and dips rich in brain building fats with the crunchy cracker favorites.

-       Is Friday pizza night? Give your own homemade a try, and let your kids in on the project. If making your own dough is daunting, purchase an empty pizza round from your grocer’s freezer section and build from there. Use organic cheeses. Experiment with toppings like olives, fresh basil leaves, raw tomato slices, scallion, or barbeque chicken; let your kids spice the pie with fresh minced oregano, raw minced garlic, or  fresh hot pepper.

-       Use a crock pot once a week for a home cooked meal. Meatballs and sauce, meatless minestrone, pot roast and vegetables, and lentil dahl are just a few meals that cook themselves and offer protein, minerals, fats, and oils.

What I usually hear in my nutrition practice is this: The more families get into preparing real food, the more they get into it. It grows on you. And the best part is seeing your children become healthier and happier, from the inside out.

All kids need strong nutrition.

Top Five Things You Can Do Right Now

If it isn’t overwhelming enough to juggle the impact of a new diagnosis, special therapies, school meetings, doctors appointments and more, now you might be wondering: Do I really have to do this special diet thing? Where do I start? Here are facts you need, plus the top five things you can do nutritionally, to support your child:

1 – Replenish missing vitamins and minerals for picky eaters with the right high potency supplement

2 – Restore fats and oils essential for brain and nerve processing. Buy a good fish oil, flax oil, chia seeds, and/or flax oil supplements; add ample servings of organic eggs, nuts, seeds, and grass fed meats

3 – Yank all processed food. Period. Ditch everything with corn syrup, artificial sweeteners, colorings, flavorings, added sugars, dyes, and genetically modified foods. Replace with whole foods, real food, and home cooked food as much as possible.

4 – Try elimination diets, starting with gluten, casein, and soy free diet. Stick with it for at least four months, preferably six.

5 – Add high potency probiotics

Facts to know before you start: 1 – Nutrition deficits can cause lifelong impairment in learning, IQ, and development. More than half of children with special needs including autism may have nutrition problems big enough hinder them. Regardless of other therapies, do everything you can to optimize your child’s brain and body for growth and learning, with good nutrition. Without this, the brain functions below potential, and your child may not get the full benefit of other therapies. The earlier children receive optimized nutrition, the better, but you can begin at any age. Note: Good nutrition happens with the right foods and supplements going in, and healthy eliminations going out! If your child can’t comfortably pass stool daily, needs reflux medicine, or relies on medications for constipation, then you have work to do to optimize nutrition.

2 – In the US, physicians get little to no meaningful training in nutrition. They are not trained to apply diets and nutrition as therapies, much less for children with developmental disabilities or autism. So to get started, be sure you also talk to families who have succeeded with nutrition and special diets for their children with autism. My practice has specialized in this since 1999. For more resources, see TACANow.org.

3 – Nutrition and diets treat the nutrition and gastrointestinal problems children with autism often have, not the autism itself. A “side effect” of these treatments is that the brain and body function better. This would be true for any child with a nutrition deficit or gut disease. Get your child assessed by a knowledgeable physician or licensed nutrition professional for these problems. For in-depth strategies on how to do that, see my book Special Needs Kids Eat Right.

Fresh and local gluten free pasta at Boulder's Farmers' Market

So You Want To Try “The Diet” Guess what? There is no “diet for autism”. There are several nutrition approaches, including various diet strategies, supplement procotols, and gut health tools. Which one is right for your child? Though each child may have different nutrition priorities, there are many common nutrition findings for kids with autism spectrum diagnoses. So, it’s reasonable to start with these tips below, to replenish your child toward better health and functioning. For detail on how to thoroughly launch a successful intervention, see Special Needs Kids Eat Right: Strategies To Help Kids On The Autism Spectrum Focus, Learn, and Thrive.

If you don’t see progress, don’t give up – this likely means your child’s biggest nutrition problems remain undiscovered, not untreatable. Get help from others who have succeeded, talk to knowledgeable professionals, and check for meetups and support groups in your area.

1 – I’ve reviewed hundreds of food intakes of kids on the autism spectrum, so I can vouch for their legendary picky eater status. Their diets tend to be weak for minerals – so, mineralize! Put back missing vitamins too. These are critical co-factors for learning, mood, sleep, and energy. Give your child a high potency multivitamin and mineral supplement daily. Pick the format best for your child: Chewable, liquid, capsule, or powder. Then get started. Multi’s built for this task may not be on store shelves, such as these examples, available from health care providers or on the web:  ProThera VitaTab, Klaire Labs VitaSpectrum, or Kirkman Labs TheraResponse. Each of these delivers high potency minerals with full dose or higher for B group vitamins, another notable helper for kids with autism. Caveat: Don’t give more than indicated for your child’s weight, and use these in the morning or early afternoon, not in the evening. If your child uses medications, check with your pharmacist or doctor on when to take a new supplement: Some drugs impede nutrient absorption, and vice versa. Browse these products right now from the Nutrition Care For Children virtual dispensary that I set up for my own patients. Enter with access code MyNCFC and password 80303 (my office zip code). Follow the prompts from here to set up your own account, if you want to purchase.

2 – Kids eating mostly processed starchy foods get nearly no healthy fats and oils, which are essential for the human brain to grow and function. If possible, add nuts, nut butters, seeds (sunflower, pumpkin, flax), meats, eggs, or olive oil, and give your child an omega 3 fatty acid supplement daily. Use about 1000mg to 3000mg of mixed “DHA” (docohexaenoic acid) and “EPA” (eicosapentanoic acid). Choose a high quality brand carefully screened for mercury and potency, such as Pharmax, Spectrum Essentials, Nordic Naturals, or Barlean’s. Barlean’s makes a product even picky children like called “Omega Swirl” which is good on pancakes, muffins, cupcakes, or just off the spoon. Caveat: Children on medications for bipolar disorder should check with their prescribers first to review safe dosing of EPA omega 3 fatty acid. These products can also be browsed in the dispensary.

3 – Ditch processed food, sugar-added food, and junky drinks, punch, soda, and flavored waters with artificial ingredients. Period. It may sound impossible, but it isn’t. Roll up your sleeves and commit to your child’s better health and functioning. Artificial ingredients like colorings, dyes, fake sweeteners, corn syrup, genetically modified foods, and flavorings have been linked to ADHD, behavior challenges, and even organ damage. High fructose corn syrup has been found to contain mercury, leftover from its processing. Map a plan that you can live with to replace all those convenient snack foods and frozen items, and switch in real whole foods – organic if you can afford it. Take on as much as you can – even a few more servings of real, wholesome food over processed empty food will begin to help your child each week. Even if you can only manage removing all foods and drinks with high fructose corn syrup, it’s worth the effort.

4 – Ready for more? Trial an elimination diet, by eradicating all dairy protein (casein, whey), all gluten (wheat, rye, some oats, barely, and many flavorings, seasonings, condiments), and all soy. Start here for help on how. Starting with gluten makes sense simply because there are so many gluten free versions of food now available, from pasta and bread to pie crusts and pretzels. Then work on the milk, cheese, butter, yogurt, ice cream – any and all sources of foods made with cow’s milk or cheese have to go. Substitutes for cheese and milk are a little trickier, but still workable (Note: Do not switch in soy milk or soy yogurt!). These foods cost more, but you may be saving money in the long run because of your child’s improved health and functioning. Give this trial at least 4 months, no cheating. See my book Special Needs Kids Eat Right for more on why soy can cause your intervention to fail, the rationale for elimination diets, and how to implement them successfully.

5 – Gut it – That is, get your child’s gut functioning optimally. If your child is dependent on medications for constipation and reflux, then it’s time to clean house – this means nutrients are not absorbed to potential. Talk with your doctor about how to wean off of those nutrient-robbing medications. If no alternatives are offered, see Special Needs Kids Go Pharm Free for strategies to help your child have normal bowel function without prescription medications that interfere with nutrition. A simple start: Give a chewable high potency probiotic daily like Klaire Labs Prodegin (also in the dispensary), daily for 2-3 months. If no progress and those medications are still needed, consider talking to a naturopathic doctor (ND) for more ideas.

This is only the beginning. Your child’s birthright of strong nutrition will help replenish him to his potential, autism or no. Dive in, reach out for help and support, and stick with it.

He also sits us both down before the shop, to pin down exactly what our meals will be for the coming week. That can be the hardest part – we blank out. So we keep a list of dinners made over the years and add to it often, when we find a new idea we all like. This has really helped my family eat well. We are spendy on good organic food, and don’t eat out often – something not all families can swing – but just the act of choosing what’s for dinner a week in advance is a worthy time, money, and health saver. Here’s some ideas to get you started – in my house, these meals have to be free of gluten, soy, corn, dairy, and most nuts.

Salmon with saffron sauce and chick peas

…Salmon with saffron sauce and chick peas (Recipe from Hummus and 65 Other Delicious Recipes) with brown rice

…Minestrone Soup from scratch (Recipe from Special Needs Kids Eat Right) with GF Chebe rolls (store bought mix)

…Meatloaf (Recipe from Special Needs Kids Eat Right) with quinoa cooked in chicken broth, green salad, green beans. Sounds pedestrian but try this recipe. It’s good.

…Vegetable Frittata over GF Penne (use any veggies but we like asparagus, onion, spinach, mushroom, and pepper)

…Lentil Shepherds Pie with green salad (here’s the basic idea of this recipe; we use So Delicious or Silk coconut milk instead of cow’s milk, ghee, and green beans instead of corn)

…Pork or Chicken Adobo with brown rice and baked sweet potato

…Spaghetti and meatballs (from Special Diets for Special Kids), green salad, summer squash with oregano, Chebe rolls

…Curried chick pea skillet dinner (from Special Needs Kids Eat Right) over spiral GF pasta

…Coconut chicken curry with sweet potato over rice

…Thai red curry sauce over mahi or haddock (if available) from Blanchard’s A Trip To The Beach with GF risotto and ginger carrots (slice fresh carrots into skillet with olive oil and fresh ginger slices. Add a dusting of curry powder, dash honey, and enough chicken broth to keep from sticking. Cook to desired softness over medium heat).

Adding lemon slices while cooking chicken picatta makes it even better

…Portuguese kale soup (recipes abound, our own version is in Special Needs Kids Eat Right), Chebe rolls.

…Kale calzones with brown rice green pea salad

…Roast chicken, potato, onion, carrot – baked in one big Pyrex. We buy a half chicken with skin; the organs that come with it go to the cats.

…GF penne pasta with pesto – we make ours with pine nuts, which are safe in our house (not walnuts), and skip the parmesan in the recipe.

…Stuffed bell peppers (blanch the peppers, then stuff with whatever mixture you like: raisins, bread crumbs, leftover minced pork or ham, pine nuts, cashews, onions, mushrooms, brown rice, your favorite seasonings – then bake), chicken sausage

…More: Lemon chicken picatta, home made chili, pork loin, stuffed pork chops or chicken (we use mushrooms, minced ham, onion, bread crumbs – whatever is on hand); pot roast or beef stew, lentil soup and hot dogs

…A side of fresh vegetable, stir fried greens, and/or fresh garden salad with homemade dressing is almost always on the table, when vegetables are not featured as a main course.

No doubt I am blanking out again as I type, which is why I keep cookbooks on hand that I like to thumb through again and again – like The Victory Garden Cookbook (1982), Yankee Magazine’s Favorite New England Recipes (1972), Whole Life Nutrition Cookbook (2006), Top One Hundred Pasta Sauces (1987), Gluten Free Italian Cookbook (2008), Hummus and 65 Other Delicious Recipes (2006), a now dog eared Joy of Cooking that was given to me in 1979, and many others. Whether you can manage just one or two home cooked meals a month, or several a week, make them special occasions where your family knows they are being cherished with good healthy food.

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 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 ripe banana, 1 cup almond milk, dash vanilla flavoring, 1/2c crushed ice, 2 TBSP sesame tahini, dash cinnamon. Add cacao nibs or if you don’t have those, organic dark chocolate chips (1 TBSP) 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 agave 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, 2 teaspoons maple syrup, 1 TBSP sesame tahini, 3 TBSP cashews, 4 ounces almond 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, 6 ounces So Delicious or Silk coconut milk, 2 teaspoons honey, crushed ice; add more coconut milk to desired texture

Pineapple Smoothie: Fresh pineapple chunks ¼ cup, 1 ripe banana, 2 TBSP whole coconut milk, 4 ounces So Delicious or Silk coconut milk or almond milk, dash vanilla, 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 teaspoon honey

More ideas..

-       For any smoothie with fruits like kiwi, berries, papaya, peaches, pear, or mango, adding a raw egg 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.

-       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, and talk with your child’s health care team.

Nope. Not eating that.

Many clients in my pediatric nutrition practice over the years have been children who tried feeding clinics. Kids needing this intervention are the pickiest of the picky. They don’t eat well, have a very narrow repertoire of acceptable foods, and are often not growing well as a result. They seemingly self limit their intakes by choice. Feeding clinics are part behavioral intervention, part social group (peer pressure is leveraged to help kids try more foods), and part occupational therapy. They include strategies to get young children eating more, and get them past texture aversions, gagging, squirreling food in their cheeks, spitting food out, or rigid beliefs about foods.

I’ve met a lot of feeding clinic flunkies – kids who stumped teams of psychologists, speech and language pathologists, GI doctors, and occupational therapists. What went wrong?

In some cases a swallowing issue is uncovered, and an occupational therapist as well as a speech and language pathologist can help correct this. Otherwise, an assumption may have been made that there is no physical rationale for the child’s eating pattern, that it is purely psychological. This is when I often end up finding a physiological backstory. Fix that, and appetites can improve. Eating becomes a non-issue, stress for the entire household drops several notches, and the child can begin eating and growing normally again.

What physiological gaffes can create a picky eater monster? Here are the usual suspects:

1 – Reflux medication. My first task to improve appetite in this case would be to wean off the medication. My opinion? These medications are rightfully earning a bad reputation. They are over-prescribed for infants and children. They are associated with lesser bone density (and fractures in older adults), and lower digestive capacity in general. They make it harder for many nutrients to be absorbed, notably, minerals like calcium and iron, and vitamin B12. Reflux medicines also let fungal infections (Candida or yeast) flourish at the expense of healthy gut microflora. I have seen at least one case of stunting due to long term use of reflux medicine. Leaving a baby on this medication during crucial developmental years means optimal levels of nutrients will not reach brain, bones, and body tissues.

By lessening stomach acid, reflux medications leave food sitting longer in the stomach, where it will remain poorly digested and eventually pass into the small intestine, less ready for further digestion. The result can be constipation or loose stools, bloating, gas, more reflux, and – never feeling very hungry. Strategies to wean off reflux medicines – and how to avoid them in the first place – are discussed in detail in Special Needs Kids Go Pharm-Free. Be sure to tell your doctor if you would like to wean this out of your child’s regimen.

2 – Intestinal candidiasis. This is a Candida (yeast) infection within the intestine or GI tract. While Candida is an ordinary resident of a human gut, it can take over and become detrimental to appetite, eating, and stooling when children have had repeat antibiotics, when children are born via C-section or spend time in NICU, or when there is any circumstance that suppresses colonization of the intestine with normal microflora. Since at least one vaccine on the infant schedule is made from recombinant technology that uses yeast cells, some children develop yeast struggles from this even though they’ve never had antibiotics. A yeast-heavy gastrointestinal system will have a pH that weakens digestion. The result is a little like too much reflux medication: Bloating, gas, constipation or loose stool, and picky appetite. Kids in this boat tend to be fiercely preferential for starchy sweets, bread, ice cream, pizza, noodles – a white diet of refined carbs. Treating the yeast infection with the right medication, diet, herbal tools, or probiotics can move your child to eating healthfully and heartily.

3 – Undiagnosed food sensitivities. Food allergy is not so hard to see: Usually there are hives, rashes, eczema, stomach pain, tingling at lips, tongue or throat, or vomiting. But food sensitivities can be operating with little to no obvious symptoms other than weak picky appetite. These can be detected with a blood test called ELISA IgG to specific foods. Identifying problem foods and prioritizing how to rotate them can ease a child’s discomfort and aversions to foods.

4 – Mineral deficiencies. Picky eating raises a flag for mineral status. Iron, zinc, and other minerals all influence appetite. These can be checked with blood tests, and easily supplemented if needed. There are reliable clinical signs for mineral deficiency states too. See Special Needs Kids Eat Right for a table on detecting mineral imbalances without drawing blood.

If you have an epically picky eater, take heart – there are many nutrition strategies that may crack this nut for you. See either of my books for details.