It Takes a Village – And Then Some!

It Takes a Village – And Then Some!

by Erica Leon, MS, RDN, CDN

While not easy, I somehow launched my children into college and beyond. With fellow empty-nester friends who are also health professionals and moms—one a nurse, one a psychologist—I took a walk down memory lane. We reflected on teaching children good self-care, particularly when they have health concerns related to food.

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Peanut Allergy:

Carpooling was challenging enough, but when I thought three-year-old Thomas had shared my son’s peanut rice cakes, I panicked! Thomas was severely allergic to peanuts as well as tree nuts. Still parked at the nursery school, I hoisted Thomas like a football, screamed for the teachers, and rinsed his mouth, hoping I did not have to administer his EpiPen. He never ate any of the rice cakes, but I learned a valuable lesson on scrutinizing food items when you have or care for a child with allergies!

According to Hildie Kalish, RN, an elementary school nurse whose child has a severe nut allergy, “Keep your child safe by constantly checking and then rechecking ingredients in food products. Never assume an item is safe as it is not uncommon for food manufacturers to change ingredients or processing techniques. As soon as children are old enough to understand, teach them to read labels and avoid sharing food with other kids. When they are responsible enough, have them carry Benadryl and their own Epi-pen or Auvi-Q, and make sure they know how to use them.”

Dehydration:

My nutritional skills were put to the test when I rescued ten-year-old Luke, my son’s friend, who was dizzy from playing baseball in the summer heat. Driving up with hydrating sports beverages and a mom’s wisdom, I remembered that Luke had an endocrine condition that made dehydration particularly dangerous. When a child exercises, their muscles generate heat, which in turn raises body temperature. The body cools itself through sweating, which must be replaced by fluid or the body will overheat.

Dehydration is more common in children, and young athletes are particularly prone to dehydration. Encourage your young athlete to drink fluids before, during, and after sports to prevent heat-related illnesses. Recommend fluid-rich foods such as fruits and vegetables and have your youngster carry a water bottle and drink a sports beverage when his/her physical activity level exceeds one hour.

Celiac:

I became a celiac expert when Rachel, a good friend of my daughter’s, was diagnosed. From that day forward, I stocked my cabinets with gluten-free items and helped her mom educate other parents about which foods to keep on hand for play dates.

 Merle Keitel, Ph.D, counseling psychologist and parent of a child with celiac, says,

“It is important to establish a support system that is aware of your child’s dietary restrictions and has food on hand that your child can eat if at their homes for an extended period of time.  In the case of celiac, fruits and vegetables work but if other children are having sweets, it is helpful for there to be chocolate or other gluten-free sweets so the child does not feel cheated and self conscious about being ‘different.’ Friends and extended family who are educated and willing to help can be a gift to the child with special dietary needs.”

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These real-life scenarios portray what can happen when a child has a chronic health condition. Says Kalish, “At school I work with families of kids newly diagnosed with Type 1 diabetes. I always say that education is key. I see parents overcompensating with extra treats for fear that their child will feel deprived. Diabetic children do not need extra treats. It is important to treat them like any other child and learn the merits of a healthy balanced diet with plenty of ‘everyday’ foods and occasional ‘sometimes’ foods.”

While we can try to protect our children from all types of threats, educating your child, caregivers, schools, and trusted friends about a chronic health condition is essential. Allow your child to take the reigns and manage his/her own health as soon as he/she are emotionally and intellectually ready. We want our kids to remember the lessons that we teach them at home, as they will eventually leave the nest.

Gluten-Free: Diet Trend or Medical Necessity?

Gluten-Free: Diet Trend or Medical Necessity?
By Julie Holland Faylor, MHS, CEDS

 

Open a magazine, visit a restaurant or shop for groceries and you’re likely to observe the gluten-free diet craze. Books, magazines and blogs claim various health and weight loss benefits from eliminating gluten from our diets, restaurants tout separate gluten-free menus, and grocery stores have added whole aisles dedicated to gluten-free foods. In fact, the gluten-free eating trend has become so pervasive that there’s even a gluten-free Girl Scout cookie!

For many people, gluten-free eating is the latest fad. However, for people like me with celiac disease, it’s a necessity. According to the National Foundation for Celiac Awareness, only 1 in 133 Americans have celiac disease, a genetic autoimmune illness that damages the small intestine and restricts the body’s ability to absorb nutrients from food. People who have this disease cannot tolerate gluten, a protein found in wheat, rye and barley. If any gluten is ingested, even a small amount, uncomfortable medical symptoms develop shortly afterwards, including abdominal pain, diarrhea, vomiting and constipation. In addition to those with celiac disease, there is a portion of the population who have non-celiac gluten sensitivity. These people also cannot tolerate gluten, and while they may experience similar symptoms, they don’t experience the same damage to their small intestine.

As an eating disorder specialist, two things are concerning to me about the swift rise in gluten-free diets—the connection between dietary restriction and eating disorders, and the impact of the growing popularity of elective gluten-free eating on people without medically-verified gluten intolerance or celiac disease.

Eating disorders often begin with a seemingly innocent diet—medically indicated or otherwise—and many diets call for the elimination of entire food groups like gluten, dairy or meat. Sometimes, dietary restriction can lead to disordered eating behaviors like “orthorexia,” a condition characterized by an unhealthy preoccupation with healthy eating. In other cases, dietary restriction can lead to a full-syndrome eating disorder (the dieting behavior activates the latent genetic predisposition toward developing an eating disorder—remember, eating disorders are hereditary! Link to first post) For individuals without a medically diagnosed gluten intolerance that elect to stop eating gluten, I encourage them to think about why they are making this significant change to their diet. In general, whole grains are an important part of a balanced pattern of eating, and labeling foods as “good” and “bad” can stigmatize eating and reinforce the cycle of dieting and dietary restriction. A simple best practice following any significant change in food intake is to consult with a registered dietitian to establish an optimal nutrition plan. While doing so, it is important to specify that the gluten-free change is a dietary preference rather than a medical necessity. Regardless of our diet choices or mandates, it is important to keep wellness and balance in mind.

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Additionally, the gluten-free diet fad creates a misperception that gluten-free is merely a preference, not a medical necessity. As a result, gluten-free standards have relaxed to the point where many products and menus claiming to be free of gluten actually contain some measure of wheat, rye or barley. This makes it more challenging to practice a medically-indicated gluten-free diet. While food products must list their ingredients, gluten-free menus at restaurants can be blatant offenders, not taking the time to truly understand what gluten is and in what products it is used. In my personal experience at many restaurants, I have ordered meals from these special menus that actually contained gluten ingredients like soy sauce, and I felt terribly sick shortly after. In a sense, it seems as though elective gluten-free eating has trivialized a celiac disease diagnosis. I encourage those with gluten intolerance to be hyper-vigilant about their product choices and restaurant visits—in light of the gluten-free trend, we have to listen to our bodies even if a label or menu item claims to be gluten-free.

In today’s culture, dieting is pervasive. Gluten-free eating is all the rage this year, the latest in a long line of fads and gimmicks like low/no-carb, high protein, raw, fat-free, sugar-free—the list goes on and on. While the majority of diets are elective in nature, some diets—including the dietary restrictions of individuals with celiac disease—are medically indicated. Regardless of the motivation for the diet or the diet’s underlying philosophy, it is important to understand the connection between dieting and eating disorders. In fact, research has found that 35 percent of “normal dieters” progress to pathological dieting, and of those, 20-25 percent progress to partial or full-syndrome eating disorders.* With this statistic in mind, caution must be exercised when any sort of dietary restriction is taking place.

 

* Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The Spectrum of Eating Disturbances. International Journal of Eating Disorders, 18 (3): 209-219.