Expert Profile: Dr. Janice Joneja is a researcher, educator, author, and clinical counselor with thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerance. She holds a Ph.D. in medical microbiology and immunology, and is also a dietitian (RD), registered in the College of Dietitians of British Columbia. She is an adjunct professor in the Faculty of Agricultural Sciences at the University of British Columbia, and an Honorary Research Fellow in the School of Biosciences at the University of Birmingham in England. She is the author of several books including Dealing with Food Allergies: A Practical Guide to Detecting Culprit Foods and Eating a Healthy, Enjoyable Diet
and Dealing with Food Allergies in Babies and Children.

30 Years ago Janice Joneja found herself in a situation no parent wishes on another. Her son had asthma, eczema and horrible reactions to certain foods including vomiting, migraine headaches and anaphylactic shock (to peanuts).

At the time, very little was known about food allergies. In fact, after her son was hospitalized at age 13, a psychologist recommended he stay with someone else because he deemed “stress at home” the cause of his bad reactions.

Even with a PhD in immunology, Dr Joneja could not help her son get better. The more expert advice she sought out, the more that she realized that the research in this area — and help to struggling parents — was almost nonexistent. So she decided to focus her work and research on food allergies and helping families in need. This led to the development of her company, Vickerstaff Health Services Inc.

After talking with Dr. Joneja, and reading the latest research on food allergies, I found out some surprising tidbits of information. But before getting started, let’s review the basics.

Food Allergy 101
According to clinical guidelines developed by the National Institute of Allergy and Infectious Diseases (referred to as The Guidelines throughout this post), the definition of a food allergy is, “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.”

Food allergies always involve an “immune response.” The allergen-specific immune cells mistakenly see the food component (typically protein) as a threat to the body and then they react. Symptoms can include vomiting, diarrhea, skin rash/lesions, itching, swelling, difficulty breathing, blood in stool and worsening of asthma and eczema .

“The problem is not with food as people think, it’s the body’s response to different food components that causes problems,” says Joneja. “After food is eaten it goes through a complex system of digestion and specific immune responses.”

According to the Food Allergy and Anaphylis Network, 8 foods account for 90 percent of all food allergies. These items, called food allergens, include wheat, milk, egg, peanut, tree nuts, fish, shellfish and soy. Although studies show food allergies are over-reported, scientists believe they have increased over the last 10 to 20 years.

Some kids are at higher risk for developing food allergies including those with a parent or sibling with asthma, allergic rhinitis, atopic dermatitis or food allergy. According to the CDC, children with food allergies are two to four times more likely to have conditions like asthma, atopic dermatitis and respiratory infections.

So with this in mind, let’s get to the information every parent must know about.

1) Delaying the introduction of food allergens is unnecessary: According to The Guidelines and a report by the American Academy of Pediatrics, there is little evidence that delaying the introduction of solids past 6 months, and waiting to introduce potentially allergenic foods, prevents food allergies.

“Parents who wait to introduce food allergens to their kids may miss a window of opportunity,” says Joneja. “If young children don’t get exposed to low dose food allergens their GI system can mature to the point where their body may not tolerate it.”

Joneja explains how health professionals used to recommend young children avoid food allergens until they were older. Now the opposite is believed to be true.

Being the neurotic parent I am, I asked her about life-threatening reactions to foods like peanuts. My thought was it might be better to wait until a child is older so they could communicate with you. Joneja said that this anaphylactic complication not only is rare (<.2%), but is more likely to happen in late adolescence and adulthood.

As far as prevention, there is strong evidence that exclusive breastfeeding for at least 4 months helps prevent atopic disease and some evidence that hydrolyzed infant formulas reduce allergy to cow’s milk for at-risk infants. Joneja says that only women with known food allergies need to exclude food allergens from their diet.

2) Not all reactions to food are food allergies: When someone has a reaction to food it is not always a food allergy — it can also be a food intolerance. As said earlier, food allergies involve an immune response. Food intolerances do not and their cause is either metabolic, pharmacologic or undefined.

One example is milk allergy vs. lactose intolerance. A milk allergy is an immune response to milk protein where lactose intolerance is the inability to digest lactose in milk.

Other intolerances that adversely affect behavior may be caused by food additives such as artificial colors and certain preservatives. Many parents still think sugar sends their children climbing the walls but research shows it’s more likely to the additives in the food (more on this fascinating subject in an upcoming post).

According to a recent study published in the Journal of the American Medical Association, 30 percent of people believe they have food allergies when only 5 percent of children and 8 percent of adults do.

3) Most kids will outgrow food allergies:“90 percent of children out grow food allergies by the age of 7″ says Joneja. “Sometimes parents will see tolerance of food allergens as early as two years of age”

Joneja explains how developing a food allergy as a young child is the best case scenario. That’s because food allergies in children are much more likely to be out grown than those that begin later in life.

According to The Guidelines, children with allergies to milk, egg, wheat and soy generally resolve while allergies to peanuts and tree nuts are more likely to persist. So if your child has a food allergy, make sure to talk to your pediatrician about when and how to re-introduce allergenic foods.

4) Blood or skin prick tests alone cannot diagnose a food allergy: Joneja says that IgE antibody blood tests and skin prick tests are only 50 percent accurate and can result in false positives or negatives. She believes skin prick tests to be the least accurate and problematic — and does not recommend them.

Instead of relying on single tests, The Guidelines recommend a variety of tests for food allergies including medical history, blood tests, food elimination diets and oral food challenges. Talk to your pediatrician or allergist about the combination of tests best for your child.

5) Older children can still develop food allergies: Once a child has tried most foods, parents may sigh a big relief that their child is food-allergy free. But in some cases, food allergies can appear in adolescence and even adulthood.

Milk, eggs and peanuts account for the vast majority of allergic reactions in young children while peanuts, tree nuts and seafood are more common with teenagers and adults. Sometimes in older kids the allergic reaction only occurs with exercise, alcohol consumption and non-steroidal anti-inflammatory use.

Allergic reactions to food or food additives can be immediate or delayed. Immediate reactions occur within minutes to a few hours while delayed symptoms may take several hours to a few days. This is it’s important to wait a few days after introducing a new food to babies and toddlers.

There are still many myths about the development of food allergies in kids and adults — and the science will continue to evolve. Restricting young kids’ diets or delaying the introduction of solids unnecessarily can cause nutrition deficits. So if your child is at higher risk for developing food allergies, or is experiencing signs and symptoms, make sure you see an experienced food allergist.

Anything written here surprise you? Would love to hear about it in the comments.

References

National Institute of Allergy and Infectious Diseases Guidelines For the Diagnosis and managment of Food Allergy

AAP Policy Statement: Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children (Jan 2008).

Chafen JJ, Newberry SJ, Riedl MA, Bravata DM, Maglione M, Suttorp MJ, Sundaram V, Paige NM, Towfigh A, Hulley BJ, Shekelle PG.
Diagnosing and managing common food allergies: a systematic review. JAMA. 2010;303(18):1848-1856.

Expert Profile: Diane Keddy, MS, RD, FAED is a Nutrition Therapist and a Fellow of the Academy for Eating Disorders. She has treated men, women and children with eating disorders, including selective eating, for the past 25 years. Currently she is in private practice in Newport Beach, CA.

If all children accepted the food parents gave them, feeding kids would be easy. In fact, this is usually what happens the first 18 months to 2 years of a child’s life.

But then one day the same child who ate almost everything starts to say “no” and reject foods. In the eyes of a child, new foods can be scary and intimidating. And parents are left unsure what to do, afraid their little one will become deficient in key nutrients.

Welcome to Raise Healthy Eaters’ picky eating series. Here we’ll talk about why kids eat the way they do and what parents can do about it. I believe what happens during this lengthy stage of development can have a big impact on a child’s future eating.

But before we get into what is normal for most kids in terms of food choice and eating habits, it’s vital to discuss what isn’t normal. There are times when kids may require professional help if they are to become normal eaters.

Selective eating
Selective eating is picky eating that persists into middle childhood and beyond with an extreme reluctance to try new foods. Unlike eating disorders, there are no body shape issues and weight of the child can vary, with many children being underweight.

“Most pediatricians are missing it,” says Diane Keddy, MS, RD , FAED, a nutrition therapist who has worked with selective eaters for 10 years. “The longer parents wait to get help, the harder it is to treat.”

Now this doesn’t mean that any 10-year old picky eater has selective eating. Keddy says these kids only accept a very narrow range of (usually white) food. The typical list includes pasta, macaroni and cheese and gold fish and some will drink milk.

Selective eaters tend to only eat their accepted foods at home even if someone else is making it the exact same way. When they try a new food it’s common for them to choke, gag or even vomit which leads to their anxiety about eating. Keddy explains that this is neurological because the part of their brain that recognizes food as pleasure is underdeveloped.

Typically by age 6 kids really start expanding their palate but with selective eating this doesn’t happen, making social activities anxiety-ridden for the child. They often fall off the growth charts and can experience slow bone growth if left untreated.

Who gets it?
“Children with a family history of autism, eating disorders, OCD and severe picky eating are at greater risk for developing selective eating,” says Keddy. “With autism spectrum disorders (ASD) on the rise, selective eating is becoming more common.”

A recent study published in the Journal of Pediatrics, showed that while both ASD and non ASD children had picky eating, the ASD group refused more foods and had a smaller repertoire of foods they would eat. As a result, these children had insufficient intakes of vitamins A, C, D, zinc and calcium.

This doesn’t mean non ASD children can’t become selective eaters, but it appears to be more common in children with ASD.

The treatment
Keddy says that the treatment for selective eating is very different than what she recommends for normal picky-eating kids. The division of responsibility of feeding does not work with selective eaters. She utilizes a treatment called “systematic desensitization.”

Children are first put on medication to treat their anxiety. Once their anxiety is reduced and they are better able to relax, she works with them on trying different foods. For each new food they try, the parents give them some kind of non-food reward.

She describes it as a negotiation, where kids are allowed so many “pass” foods. She says the treatment takes a lot of energy and commitment from parents, but it’s worth it. Based on her own experience, she estimates that about 80% of selective eaters eventually become normal eaters.

What worried parents should do
“Parents know their kids best,” Keddy says. “If they sense something is wrong, they should seek professional help.”

Keddy says to start with the pediatrician and if they can’t refer you to anyone, find a dietitian that works with eating disorders. She says that even if the pediatrician says your child’s eating behavior is not worrisome, it’s worth it to get them evaluated. “It can’t hurt,” she adds.

The sooner kids get treated for selective eating, the better off they’ll be. Keddy says the average age she sees kids are 10. But children often display signs at much younger ages, typically starting around ages 3 to 4.

And if left untreated, kids who are selective eaters will grow into adults who can only eat a short list of foods. This not only negatively impacts health but hampers social activities where food is often the central part of gatherings.

So when in doubt, get your child evaluated. If this isn’t an issue for you, stay tuned for our next post in this series about the kind of little eater you have at home (and why it matters!).

Next: How to Pinpoint Your Child’s Eating Personality (and Why it Helps)

References

Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, Maslin M, Must A. Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children. J Pediatr. 2010 Mar 31.

This Expert Interview is with Michelle Segar, PhD, MPH, researcher at the Institute for Research on Women and Gender at the University of Michigan. Her expertise is creating sustainable exercise motivation and self care for women. Learn more about her and her program at Essential Steps. She’s got a lot of wisdom to share!

Sunday we celebrate moms. You might get flowers, a gift certificate or even a home cooked meal. But the absolute best gift you’ll get this Mother’s Day is the one you give to yourself.

While being a mom is incredibly rewarding, it’s easy to lose some of yourself in the process. You know, the old you that but you first. If you could get some of you back, wrapped up in a gift you could access anytime, wouldn’t you want it?

Lately I’ve been missing my old self. And I’ve decided that I’m the only one who can do something about it. I know I could never get the old me back — and I really don’t want to (because I’m better now, right?).

So I talked with my friend and colleague Michelle Segar, PhD, MPH, a women’s motivation psychologist at the University of Michigan, to figure out how moms like me can carve out a little time for ourselves. She calls it “self care.” I call it smart.

What Gets in the Way?

Dr. Segar starts by discussing the barriers mothers face when it comes to making themselves a priority.

The first one is that moms have a lot on their plates. Even though most families (65%) have both parents working, moms still do a majority of the work around the house. According to the Second Shift study, husbands do about one-third the household chores and those tend to include home maintenance. Women tend to do the everyday chores like cooking, cleaning and keeping track of kids’ activities.

Another barrier, tied closely to the first, is that women don’t know how to ask for relief.

“Women haven’t been socialized to make taking care of themselves a priority,” says Segar. “We’re just not socialized to think that way.”

Segar explains that most women never learned to consider their well-being as something that is important enough to plan and stand up for. They may feel bad saying “no” or simply don’t know the most effective way to approach their spouse or partner. This might be why so many arguments happen as resentment grows and then “pop!” Segar challenges us to consider why our own daily well-being shouldn’t be one of the most important things in our lives?

And the third barrier for moms is their tendency to focus a lot of their self-care energy on losing weight.

“So many women put their energy into getting thinner, again, and again, without seeing lasting results when instead they could be engaging in self-care activities that are more likely to nurture and restore and truly feed the self,” she says. “At its core, self-care is about feeling good.”

Segar explains that taking care of yourself is like an essential vitamin you take every day. It empowers and restores instead of zapping you of energy. Because of that, it makes you a more effective mom, friend and coworker.

So with this in mind, here are three steps you can take start taking better care of you.

1. Pause. Segar suggests before taking any action you should you assess where you are first by asking yourself how you feel.

On scale of 1 to 5, 1 being terrible and 5 great, where do you stand? If it’s a 1 or 2 on a regular basis, then things aren’t going very well, but if you get a 4 or a 5, you’re probably getting your needs met.

If you’re not happy with the way things are you need to ask yourself if it’s time to change. Segar says that making the decision is the hardest part, but to remember that you DESERVE to feel good.

2. Decide what you want.

Once you decide there’s room for improvement, you’ll want to consider what it is you want to do.

“Take a step back and think about what self-care means to you,” say Segar. “Self-care means different things to different women whether it be sleep, pampering or going for a walk.”

Segar says every woman needs to check in with her own reality. For example, a women with 4 kids under 6 years old will be very strapped for time. Even though she can’t get everything she wants right now, she can try some key things that might improve her well-being in some way.

Segar advices moms to try taking action on a much smaller scale and see it makes them feel. Try something for 5 minutes if that is all the time you have. Did it make you feel better? She also says creating a “self-care mission” is important because it will help you make a plan. And let’s face it, without a plan things just don’t get done.

3. Negotiate with your partner.

Once you know what you want, you’ll have to talk to your partner and negotiate (if you have one).

“Be frank and honest and ask for what you need,” says Segar “But then make sure to ask your partner what he or she needs too.”

Even though you may feel your partner or spouse has it easier than you, they likely have unmet needs too. By addressing his or her desires, you make the discussion about both of you getting what you want. So instead of the typical get-no-where fight, you have a collaboration. And hopefully you both will feel excited about your new plan.

Segar goes as far as recommending you have regular meetings with your partner to check in and see how things are going. You might need to revise the plan based on what is and isn’t working.

So this Mother’s Day, I say forget the candy, flowers and other fancy gifts and start asking for what you really want and need. I know I will.

How are you feeling about motherhood? Overwhelmed? Having trouble finding time for you? Any success stories out there?

I’m excited to have Evelyn Tribole, MS, RD as our expert this month. She is an award-winning registered dietitian, with a nutrition counseling practice in Newport Beach, California. She has written several books including The Ultimate Omega-3 Diet and Intuitive Eating. She is a highly respected dietitian.

“Children require omega-3 fatty acids the same way they require vitamins,” Tribole says when asked the one thing she wants parents to know about omega-3 fatty acids. “But parents need to understand that it’s not just DHA (docosahexaenoic acid) their children need, it’s also EPA (eicosapentaenoic acid).”

The problem with fortified products on the market, she explains, is they contain only DHA. And children need both. Even though DHA is the star player, DHA and EPA work together in a complex process.

In her book, The Ultimate Omega-3 Diet, Tribole argues that DHA is needed for brain development the same way calcium is required for bone growth. She says that each brain cell requires DHA for proper development. When DHA isn’t present in adequate quantities during rapid brain growth (early childhood), emotional and intellectual development can be affected.

“Kids need to eat fish at least twice a week to get the recommended amount of DHA.” Tribole says. “Parents can try fish tacos, tuna fish sandwiches or salmon patties with their kids.”

While her son was growing up, Tribole took him out for “Fishy Thursdays” and he’d try all kinds of different fish at restaurants. Now he loves fish.

“Every time the FDA comes out with a warning about fish, consumption goes down, which is too bad,” she adds. “If parents stick to low-mercury sources of seafood like salmon, trout, halibut, light canned tuna and cod, they will be fine.”

Should children who don’t eat fish regularly supplement with DHA/EPA? Tribole says yes and based on international guidelines she recommends children 2-3 years old get 433mg of DHA/EPA with a minimum of 145mg of DHA, 4-6 years old get 600mg of DHA/EPA with a minimum of 200mg of DHA and 7 years and older including adults get 650 combined with a minimum of 220 DHA. For pregnant women the DHA minimum is 300mg. Check the supplement facts label to see how much DHA/EPA is in each serving.

As for recommended supplements, Tribole put together this chart on her website listing quality products categorized by cost. Supplements especially for kids include Coromega and Nordic Naturals. For another kids’ supplement, check out my review of Carlsons for Kids fish oil.

What about vegetarian children? Tribole explains that plant sources of omega-3 fatty acids such as flaxseed and walnuts do not contain DHA/EPA and convert very small amounts of DHA in the body. Most lacto-ovo vegetarians (consumes milk and eggs) don’t have problems taking fish oil supplements but vegans may be against it. There are algae-based DHA supplements but they don’t contain EPA.

Tribole emphasizes the importance of lowering omega-6 fatty acids in the diet. “I like to compare omega-6 fatty acids to sodium in the diet,” she says. “Both are essential nutrients but too much can take a toll on health.”

Because omega-6 (see sources below) and omega-3 fatty acids compete for the same limited enzymes, too much omega-6 can crowd out omega-3s. And too much omega-6 fatty acids in the body can increase one’s risk of inflammation, increasing the risk of developing chronic diseases.

Due to changes in the food supply, she explains in her book, we eat 10-20 times the omega-6 fatty acids our ancestors ate.

“To cut back I tell families to start with three items – margarine, salad dressing and spreads like mayonnaise.” she says. “These products are made with omega-6 vegetable oils such as soybean, cottonseed and corn oil.”

Vegetable oils low in omega-6 fats include canola and olive oil. She advises families to choose canola-based margarines like Canoleo or Canola Harvest, make their own salad dressing with canola or olive oil and buy a canola-based mayonnaise.

When asked other ways families can increase their intake of omega-3 fatty acids she says they can buy dairy products that come from “pasture-fed” or “grass fed” animals – and being organic is no guarantee. When animals are fed their natural diet of grass instead of a corn-grain diet, she explains, they naturally have higher levels of omega-3s and lower levels of omega-6. One example Tribole provides is Straus Family Creamery which sells pasture-fed dairy products.

She says the Mediterranean diet is a good example of a diet balanced with the right kinds of fat. For more on this fascinating topic check out Tribole’s book, The Ultimate Omega-3 Diet.

Like what you see? Subscribe to Raise Healthy Eaters

For more on what to feed your kids see our Nutrition for Children section.

Welcome to Raise Healthy Eater’s first expert interview. Ellyn Satter, MS, RD, LCSW is an internationally recognized authority on eating and feeding. Satter integrates her 40 years of experience in helping adults be more positive, organized and nurturing in caring for themselves and their children. She is also the author of several books including Child of Mine: Feeding with Love and Good Sense and Your Child’s Weight: Helping without Harming.

“Not knowing how important they [parents] are,” Ellyn Satter says after being asked what she believes is biggest feeding mistake parents make. “Children have a drive to grow up to be just like their parents.”

But she doesn’t push parents to eat or prepare ultra healthy meals. Instead, she emphasizes family dinners as the holy grail of raising good eaters. “There’s too much guilt and anxiety with the virtue of meals” she says. “Parents get caught up in the what of feeding when they really need to pay attention to the how.”

Satter asks busy parents to make only one change at first: eat together as a family. So whether they’re eating fast food or frozen meals, all they need to do initially is gather at the table. On her website she has a step-by-step guide for mastering family meals. And she makes the focus pleasure, not nutrition.

So her first piece of advice: start with the foods your family enjoys and build on from there. This doesn’t mean pleasure and nutrition can’t coexist, they definitely can. But Satter points out that if the meals you prepare aren’t rewarding, they won’t seem worth the effort.

This is the perfect segue into my next question: “How can moms get their kids to eat vegetables?”

In addition to being an internationally recognized feeding expert, Satter is also a mom of three (now grown) kids. When her daughter was little she wouldn’t touch a vegetable but Satter took it in stride. When she brought the topic up with other moms she found them in hysterics about their non-vegetable-eating kids.

“Don’t let vegetables be the deal breaker,” Satter says, leading to her second piece of advice for families. “Once family meals become a habit, naturally find ways to add more variety to meals, including vegetables.”

Satter says the best way to get kids to eat vegetables, or any food for that matter, is for parents to eat it and enjoy it themselves. Of course she talks about the division of responsibility – parents decide the what, when and where of feeding and children decide the whether and how much of eating. She also explains the importance of “neutral,” repeated food exposure. The bottom line: kids do best when exposed to a variety of foods with absolutely no pressure to eat.

When Satter’s daughter hit early adolescence she took up a new hobby: devouring vegetables. She noticed everyone else in her family enjoying them and realized she was missing out. She is an avid-vegetable eater today not because her parents tricked her into eating greens, but because she got to the point where she wanted to eat them.

The next question for Satter is about sweet foods: how often should parents serve dessert? She says frequency isn’t as important as how it is served. Too often, she explains, dessert is the unspoken reward that kids’ can fixate on at mealtime.

To solve this age-old dessert problem, Satter advises parents to serve a single serving of dessert with the meal. “Some kids will save it, others will eat it first and some will eat it right along with the other food,” she says. She points out that this is the one time she deviates from the division of responsibility because she advises parents to only allow their kids a single serving of dessert.

“To avoid scarcity with sweet foods,” she adds, “Make sure there’s another time (snack time for example) when they can eat all they want of the item.”

Who eats dessert with dinner? Isn’t that crazy? Not really. What this feeding strategy shows children is that sweet foods, already palatable and easy to like, are not such a big deal. They are just part of the meal like the vegetables and meat.

If you think about the nature of nutrition and behavior you can see how her approach makes perfect sense. We live in a culture where the “shoulds” of eating are all around us. Eat more fruits and vegetables. Watch the fat. And make sure you skip the tasty dessert at after dinner.

Yet despite all of this scolding, recent studies show only about 3 percent of Americans lead a healthy lifestyle. Let’s face it, it’s human nature to rebel against what you should be doing (kind of like cleaning out the sock drawer). If parents can learn to feed in a positive way, their children will grow into adults who eat nutritious foods not because they feel obligated, but because they enjoy eating them.

“The data is clear – pressure children to eat, and they’ll lose interest in food; restrict their access to palatable foods and they’ll become preoccupied with them,” Satter explains. “Just provide a variety of foods with structure, eat with your kids and trust that they know exactly how much to eat.”

Watch for part two of my interview with Ellyn Satter, where she explains the surprising benefits of raising a competent eater.

Subscribe to Raise Healthy Eaters to get alerted of future expert interviews.