Demystifying the Diet
Kelly Dorfman is a nutritionist. But that’s just the beginning of it, really. Dorfman, who also has a masters of science in nutrition and biology, doesn’t just advise clients on the importance of portion control and the powers of leafy green veggies; instead, she attempts to bridge the gap between medical diagnoses (and prescriptive treatments) with what might be happening with the diet. This is not to say that she’s against traditional medicine—it’s quite the opposite—but she does believe that there is sometimes a rush to simply treat symptoms, when there’s something more system-wide going on. “The fact remains that nutritional conditions and factors are not generally part of most doctors’ medical training,” she explains. “It always pays to take as much control of your own health as you can,” she adds. “There are some doctors who are learning about nutrition and becoming certified in a brand new integrative medicine sub-specialty. The first set of physicians just took the test this year. But even if you are lucky enough to have doctor in your town who understands how to use nutrition therapeutically, you still have to do your own detective work so you can help your doctor or nutritionist help you.”
Nowhere is the need more pronounced—and critical—than with children, which Dorfman devotes an entire book to in Cure Your Child With Food: The Hidden Connection Between Nutrition and Childhood Ailments. Quite simply, it’s one of the more compelling reads we’ve picked up in a long time, whether you have kids or not. Presented case by case (Dorfman runs a practice outside of Washington, D.C.), you’ll soon be diagnosing yourself from childhood. “There’s a tendency to believe that common childhood ailments—chronic constipation, reoccurring earaches, stomachaches, reflux—are completely normal and nothing to be alarmed about, but these are avoidable and can be dealt with nutritionally before they disrupt proper development or lead to more complex medical problem,” she explains. “Ear infections, for example can lead to both speech delays and attentional issues down the road. In addition, the powerful antibiotics used to treat these common infections are not always working anymore due to overuse. When they do work they disrupt the gut flora and can lead to new digestive problems,” she adds. “In a study in D.C., it was found that 89% of the time, if you take dairy out of the diet, earaches resolve.” Here, she explains more nutritional mysteries from childhood, many of which apply to us as adults.
It seems obvious that a nutritious diet is good for kids—but just how important is it? And quite frankly, what qualifies as a good diet?
It is critically important if you want the happiest, healthiest, and smartest child possible. You and your child are basically buckets of chemicals. It may be glued together in exquisite and mysterious ways but the physical body, when reduced to its component parts, is made up of what you eat and drink. The body does not operate like a government. It cannot run on a deficit. If you don’t provide exactly what it needs, the budget gets cut. Not enough zinc? The immune system gears down and you cannot grow. And how about this one? If you don’t have enough choline, your ability to learn will be affected.
The definition of a good diet will fluctuate between different people but everyone needs plenty of fruits and vegetables: At least 4 to 5 servings per day. Less than 20% of American kids meet this basic requirement. The other general rule that applies to everyone is to eat as few empty calorie foods as possible. These are foods with lots of calories but few nutrients, like sweetened drinks and most snack foods such as crackers, cookies, and chips. Unfortunately, these foods make up 25% or more of most children’s diets. Just don’t buy them. Your kids will get plenty of junk food if you never buy another cracker or chip.
You talk about how figuring out what’s going wrong nutritionally really boils down to the fact that something is either missing from the system, or irritating the system. How do you tell what’s going on? Where should you start?
Start with your instincts. I’ve received hundreds of letters from all over the world and they are full of comments like, “I always wondered if…,” or “I have suspected for a long time that…” Then the writer reports how they have removed a food or added some supplements. Often they fixed themselves or their child because a little information gave them the confidence they needed to follow their intuition. Some problems require professional input and additional support. I got a letter this week from a mother who reported her child was not interested in eating anything. “He won’t even eat junk food,” she stressed as if this was a sign of real trouble. The youngster was surviving on a few bites of yogurt and crackers. Crackers and yogurt do not require real chewing and I wondered if he might be having trouble figuring out how to chew and swallow food. Children can have developmental delays in this area and need help learning basic oral motor skills. There are therapists, usually speech therapists with additional training who specialize in working with this issue.
The way to know if a food is bothering you is to look for signs of irritation. You or your child’s body will tell you it does not like something with a rash, a pain, or mood swings. A short list of symptoms that could point to food intolerance includes stomach pain, reflux, ear infections, frequent illnesses, red cheeks, eczema, joint pain, frequent diarrhea/constipation, asthma, temper tantrums, fuzzy thinking, fatigue, headaches, failure to thrive, excessive gas, and sleep disturbances.
Take the suspicious food out for a month, if you can. I recommend that long because there is always a birthday party, illness, or visit from grandma that might skew the trial results. You need a long enough period to see a clear trend. TAKE NOTES. If you have a mommy or daddy brain like the rest of us, you will forget in a week what you were complaining about or how often it was happening. Or you will move on to the next complaint.
Figuring out what could be missing is tougher unless you know a little about what nutrients do what. A general way you can assess your child’s nutrition status is to keep a record of what they are eating for a few days. Write it down because what you mean to feed your kids (and yourself) and what is actually eaten are often miles apart. Then imagine what it would be like to eat what is on that list. Do you think you would be energetic? Pleasant? Ready to learn something new?
If you need more input, find a nutritionist or doctor with nutrition training.
Who knew that zinc—or its absence—could create a vicious cycle that can completely derail a kid’s system? This vital nutrient affects smell and taste, meaning that when kids don’t get enough, they find many foods repulsive. “One of the deficiency symptoms when you do not have enough zinc, for kids and adults, is loss of taste and smell,” she explains. “The exact way this works is not completely understood. One of the most important enzymes in the taste bud membranes is a zinc dependent enzyme called alkaline phosphatase. Zinc is also the component of a protein found in saliva that is needed to maintain the taste buds. And there are other theories involving the central nervous system,” she adds. So, as Dorfman explains, “Picky eaters consuming a ‘white’ diet made up of dairy and flour based foods are almost always low in this vital nutrient. Lead, mercury, and food additives like tartrazine also use up zinc. Zinc is needed for growth, repair, smell/taste, brain development and proper immune functioning. The best sources of this versatile mineral are animal foods. Three ounces of beef, for example contains about 9 mg while the best plant source (pumpkin seeds) has 2.9 mg in an ounce.” While Dorfman was loathe to put an exact number on it, since everyone is different (and age, obviously, is a factor), she likes to see diets with at least 10mg of zinc a day in children who are four and up. “The Daily Value (set by the government) is the amount needed by most people to prevent deficiency symptoms. In other words, this is not an optimum amount or the maximum amount a person needs but the low bar. The amount someone needs depends on how well they absorb nutrients and the rest of their diet. If there are any signs of low levels (picky eating, taste/smell sensitivity, vegetarian diet) 15-20mg might be more appropriate, however you should check with a health care provider with nutrition training before jumping to conclusions.”
Dorfman’s list of other zinc heavy hitters:
|Lamb (3 oz.)||7.4 mg|
|King Crab (3 oz.)||6.5 mg|
|Wheat Germ (1 oz.)||4.7 mg|
|Lean Pork (3 oz.)||4.3 mg|
|Cashews (1 oz.)||1.6 mg|
|Chickpeas (1/2 cup)||1.3 mg|
Why are food allergies and intolerances on the rise? And what’s the difference between an allergy and an intolerance?
The difference between an allergy and a food reaction/sensitivity involves histamine, as allergic reactions are now narrowly defined as histamine reactions. Histamine causes irritation, swelling, and hives. If you do not have an obvious redness or inflammation reaction within a few hours of exposure to something, you do not technically have an allergy. If you get tired, grumpy, or achy, you may be sensitive or having a different type of reaction. Unfortunately, we do not have accurate tests for most other types of reactions. Over half the reactions people have are not allergic reactions. Most independent experts blame environmental changes. The climate is shifting and everything living on the earth is affected. I once wrote a letter to Al Gore to suggest he broaden his ecology message. People might pay more attention if he added a few pictures of allergic and sick children to the forlorn penguins and suffering animals he uses to illustrate what we are doing to the planet. There is no doubt pollution is impacting all of our health. One small obvious shift is distressed plants produce more pollen. Pollen counts break new records every year and more and more people are reacting.
A more direct environmental impact comes from recent changes in farming and food growing practices. Aggressive genetic modification of diet staples like corn, soy, and sugar beets and late stage herbicide application have completely altered the basic proteins in food. Since the broad introduction of genetically modified organisms in the late 90’s, allergic reactions and food intolerances have skyrocketed.
So is that why gluten sensitivities are suddenly so pronounced?
Yes, exactly: I am totally convinced the problem is due to the new farming process called dry harvesting. This started about six or seven years ago and involves spraying healthy wheat plants with the herbicide glyphosate (the active ingredient in Round-Up) about three days before harvesting. This starts killing the plants and makes them very easy to harvest. One researcher found Round-Up residues in every sample tested of wheat treated in this way. The symptoms of glyphosate exposure are strikingly similar to the symptoms of gluten intolerance…stomach distress, diarrhea, headaches, and mood changes. If the researchers are correct (and unfortunately, I think they are) this certainly explains why they cannot find an accurate test to predict gluten sensitivity that is not celiac disease. It also explains the sudden exposure of gluten sensitivity over the last few years and why people consistently tell me they can go to France or Italy and eat bread but cannot eat it here.
In your book, Cure Your Child With Food, you discuss some pretty compelling case studies about children who presented with myriad symptoms where diet/nutrition was never thought to be a root cause. Can you take us through one of your more dramatic—yet all too typical—cases?
I purposely structured the book with lots of true stories so it would read more like a mystery than a nutrition book. Nutrition books can be a tad dry which is a shame because the subject is fascinating. One of the compelling but all too typical stories was about a picky eater named Tom. Picky eating is so common that the condition is practically an epidemic. The cultural and developmental reasons have been discussed at great length and dealing with picky eaters can be very tricky, but all hope is not lost: Some of them can turn around almost overnight. Tom was famous in his family for his fussiness. If his mother could wrangle him to sit down for a meal, he would take a couple of bites and then push the plate away. And unless it was ice cream, grilled cheese, milk, pancakes, or crackers, he would not even try it.
With a diet like this, you will not be surprised to hear he seemed to be sick all the time. His mother had taken him to five specialists because of his horrible mood swings and frequent illnesses. None of the doctors could find any medical problems and declared him to be fine. The next stop was a psychiatrist for mood stabilizing medicine. Tom was four.
With a history like this, I suspected Tom was reacting badly to dairy products. He guzzled milk like it was a drug and behaved like an addict. I recommended that his mother remove milk products from his diet for at least a month. At that point we could evaluate how his mood, immune system, and picky eating were doing. The first several days were tough because he went through a version of withdrawal but within a week he was trying new foods, eating chicken, and sleeping better. It was a small miracle.
That was one of the more fascinating parts of the book, actually—when you explained that addictive behavior often points to the problem food. What’s going on there?
The main foods that cause cravings as one of the symptoms of intolerance are wheat, dairy products, and sugar. I have never seen someone who was addicted to peas or could not stop eating kiwis (though there may be someone out there who is the exception that makes the rule). The theory about why people crave wheat and dairy is called the opiod theory. This theory says some people cannot break down the gluten or casein proteins (the main proteins in wheat and milk product) properly and form a molecule that is accepted in the same receptor sites that take morphine or natural pain killers (endorphins). If you want to see why sugar is addicting, I highly recommend the recent documentary, Fed Up. [For more on Fed Up and sugar addiction, click here.]
Finding a Decent Multi-Vitamin For
The Whole Family
According to Dorfman, this is no easy feat. “There are many considerations, including the quality of the ingredients, the composition of the formula, the fillers and flavors, the contaminants, and the delivery system.” While she notes that there are entire books devoted to the right supplements, here’s Dorfman’s mini crash course. [Click here for our Vitamin & Supplement Cheat Sheet.]
Ingredient Quality. “There is no way for the average consumer to evaluate ingredient quality. You will either have to subscribe to a service that tests supplements, such as Consumer Lab, get independent ingredient verification from the manufacturer (good luck with that), or get the advice of a knowledgeable health care professional. Some products contain a GMP (Good Manufacturing Practices) stamp on the bottle meaning the company follows certain industry standards for quality.”
“A NonGMO Project Verified seal means the product does not contain genetically modified organisms (GMO) ingredients. That is a strange sounding sentence but plants that have been artificially altered with bacteria DNA are called GMO. GMOs are not tested adequately in humans, and animal studies suggest they are unsafe. Since GMOs are not labeled in the USA, some companies are voluntarily having their products verified as GMO-free. Read more about this at Non-GMO Project.”
Formula Composition. “The need for nutrients varies greatly between people, depending on their diet, metabolic quirks, genetics, medications, age, sex, and medical conditions. In a perfect world, these would all be taken into consideration. To answer the question in general, most multis for kids are weak in minerals. Try to find one that includes zinc, selenium, magnesium and chromium. These four trace minerals are often lacking in children’s diets.”
“Vitamin D is also important, and quite frankly, the sun is the best source. However, sunscreen blocks your ability to get vitamin D. If applied properly, it can block up to 90%! And, many kids are indoors a lot now. At the end of this last hard winter, all but one person I tested who did not take vitamin D was low. The amount you need will depend on where you live, your lifestyle and the efficiency of your vitamin D receptors. The only way to know exactly how much you need is to check your levels with blood tests. In general, 1000 IUs is reasonable dose for kids 3 and up.”
“As for men and women, the most important difference is the presence of iron. Men should not take iron unless they have an unusual medical condition that requires it. (Hopefully, for short periods.) Extra iron in men is a risk factor for heart disease. Women get rid of extra iron through menstruation but unless a man is bleeding regularly (hopefully, not) or has an absorption problem, he will tend to build iron up. Some companies will add extra herbs or nutrients in their multi geared towards prostate health for men or menstruation for women but the main difference in men’s multis do not have iron. After menopause, women should not take iron either unless they have a specific iron absorption problem (for the same heart health reasons). You can see this is leading up to a multiple for people over 50. And yes, they have them and they do not have iron. (Though some food based multis have small amounts that naturally occur in the foods in the supplements.)”
Delivery System. “Beware of gummy vitamins. They are delivered in a candy form so kids love them. Their parents love them also which is why they are now making adult gummy vitamins.”
“To make them extra yummy, most brands remove half the B vitamins. B-vitamins, especially vitamins B-1 and B-2 have a strong flavor and give chewable supplements a distinct strong taste. Manufacturer’s solution? Don’t put them in.”
“If kids start with gummies, they are much less likely to move over to a complete multiple vitamin/mineral that by definition will not taste as good. Make sure the multi has all the B vitamins including B-1, B-2, B-3, B-5, B-6, folic acid and B-12.”
“For adults, I generally prefer capsules to hard tablets as the hard tablets are frequently found whole in porta-potties. They can be so hard that they pass right through!”
The best multi-vitamins
we’ve found at goop HQ for little ones:
We may be all grown up, but we found ourselves diagnosing ourselves as we read your book—if something bothered us as a child, is it likely to still be an issue?
Absolutely. I could take out the chapters on ear infections and failure to thrive, use older people from my practice for the stories, and the book could be for grown-ups. In fact, adults write and tell me they figured themselves out all the time. One caveat is that the symptoms sometimes shift with age. For example, ear infections usually go away by age 4 or 5 even if you do nothing, but the older child and then adult may move on to chronic nasal drip, asthma, or frequent colds and illnesses instead.
So if something is problematic, does that mean that it should be avoided at all costs, or is this about moderation?
“Moderation” is a bombshell of a concept if ever there was one. You can use it to justify almost anything. I think I like the word flexibility better. Most people do not have to be 100% clean with their diet to make big differences. However, if you can be clean for several weeks to a month or until you get a baseline, it helps in figuring out what will work. Once you know you feel 80% better without gluten or dairy or almonds or whatever, then you can do a separate test to see if you can have some in “moderation” and what that means to you. The answer varies broadly from person to person. Some kids can have dairy products once or twice a week without getting symptoms, for example, and others cannot touch the stuff. Still others see great improvement from cutting down from 4 servings a day to 1 serving a day.
How To Get A Picky Eater To Eat
Dorfman’s E.A.T. program (Eliminate, Add, and Try) is the method by which she’s turned hundreds of kids into good eaters. Here, she elaborates on how it works. “The most important step is to decide you are serious about healthy eating. Kids smell wiggle room a mile away. Parents with food issues themselves or who are not really sure diet is such a big deal are rarely successful at changing bad habits in their kids.”
“You cannot introduce vegetables and lentils over night to a fussy eater but you can eliminate the empty calorie and addicting refined carbohydrates. Throw away the sweetened cereals, crackers, juice drinks, chips, and freezer waffles. Better to have the same few healthy foods three times a day for meals than allow your kids to fill up on sugary, salty snack foods.”
“One new food at a time. The temptation is to offer the fussy eater many choices to see if there is something he might like. This is overwhelming to the eater and exhausting for the cook. People are more comfortable with the familiar. Jumping from food to food does not allow the tenuous eater to acclimate to anything in particular. Find a food that has some of the characteristics of a preferred food but is a little stretch. For example, if the child likes French fries, perhaps work on sweet potato fries.”
“Have the child take just one bite of the same new food everyday for at least 10 to 14 days. This gives the child enough time to get over the initial shock and grow accustomed to the new taste and texture. By asking for only one bite, you make the task manageable. How do you do this with a child who refuses to get near a new food? By giving him a reason, through natural consequences, to do so. You have to ask yourself: Why should the child bother to try something new? What’s in it for her? If she screams and the food goes away, that sounds like a system that is working. The way most of us learn to do hard things is because of natural consequences. Getting out of bed is painful some days but the consequence of sleeping in is the kids don’t get to school or you lose your job so you make yourself get up.”
“When it comes to food, you want to avoid punishment or even too many rewards but without a good reason to do the hard thing of trying a new food, most kids won’t. Set up a natural consequence using when: then. When you finish with your food homework (trying one bite), then you can turn on the computer. Not, if you don’t take a bite, no computer for you, Buster.”
“If the problem is overwhelming, get professional help. Children with developmental delays sometimes lack proper oral motor skills or have other issues that require more input. Other children and parents get so stuck that they need another set of eyes to unravel the situation. There is no shame in getting the help you need.”
Nutrition Sleuthing 101