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.

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.

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

I’ve been concerned about swine flu since the very first media report. And while a part of me wants to keep my children locked up in the house, I realize that’s not a very smart (or realistic) strategy.

So instead of worrying myself sick with what I have no control over, I’ve decided to focus on what I can do. And that’s helping my kids build a super-strong immune system. So in addition to washing their hands and making sure they get enough sleep, I’m maximizing their nutrition at every meal and snack.

Nutrition deficiencies compromise the body’s (cells’) ability to effectively ward off disease. Research shows that specific nutrients are especially important for a functioning immune system. So here are 10 easy ways to bolster you family’s defenses with everyday foods.

1. Have an orange a day – During infections and stress vitamin C levels decline. Because vitamin C helps maintain the integrity of disease-fighting cells, low levels can compromise the body’s ability to fight back. Other vitamin C-rich fruits include strawberries, cantaloupe, kiwi and mango.

2. Make yogurt a regular snack – The gastrointestinal (GI) tract is the largest organ involved in the immune system. Yogurt contains live and active cultures, healthy bacteria called probiotics that are health food for the gut. Look for yogurts with the Live and Active seal.

3. Top that yogurt with some nuts – Nuts are a good source of magnesium which plays a role in the development and function of immune cells. Remember nuts can be a choking hazard for young children. I get the unsalted dry toasted sliced almonds from Trader Joe’s – they are super-crunchy and perfect for yogurt.

4. Supplement with D – Are you sick of vitamin D yet? I’m not! A recent study in Archives of Internal Medicine revealed that people with low vitamin D levels caught more colds than people with normal levels. At your next doctor’s appointment get your levels checked and consider following the AAP’s recommendation to supplement children with 400 IU daily.

5. Make winter squash a menu mainstay – One of my favorite fall foods is vitamin A-rich butternut squash. Research shows that adequate dietary intake of vitamin A is clearly needed for a strong immune system. Erin from 5 Dollar Dinners shows how easy it is to bake butternut squash. Your kids will love it!

6. Get milk – Milk contains the micronutrient copper. Deficiencies of copper can adversely affect the immune response. Don’t worry if milk is not your family’s thing as copper can be found in variety of foods including whole grains, nuts, seeds and chickpeas.

7. Make room for protein at meals – Red meat, poultry, beans and nuts are all good sources of zinc, the most studied nutrient when it comes to the immune system. A zinc deficiency can wreak havoc on the body’s ability to fight infections.

8. Be smart about fats: Studies show that getting “in balance” with fat can help the body in disease-fighting mode. So try cooking with olive and canola oils, eating fatty fish and cutting back on products made with soybean and corn oils (next month we’ll have an expert on fat explain this in great detail – so if you haven’t subscribed yet do it now!)

9. Spread avocado on a turkey or cheese sandwich – Avocados are an excellent source of vitamin E, an antioxidant that protects cells from the damage of free radicals. If you don’t love avocado there is plenty of vitamin E in nuts and canola and olive oils.

10. Have eggs for breakfast – Eggs are an excellent source of selenium. Through complicated biological processes, selenium helps prevent the formation of disease-causing free radicals. Not a big fan of eggs? Other sources include tuna, beef and rice.

Armed with a strong immune system, your family will be ready to fight anything that comes their way this winter even if it is the Swine flu.

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References

Kubena KS, McMurray DN. Nutrition and the immune system: a review of nutrient-nutrient interactions. J of the Am Diet Assoc. 1996;96:1156-64.

Ginde et al. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med.2009; 169: 384-390.

US Probiotics.org

Weaver et al. Effect of dietary fatty acids on inflammatory gene expression in healthy humans. J Biol Chem. 2009 Jun 5;284(23):15400-7.

Jenny thought her rowdy preschooler was engaging in normal “boy” behavior. But when her son entered the first grade, she started noticing that he couldn’t sit still or focus like the other kids. He was also impulsive, often endangering himself by running off at the worst times. She finally took him to a doctor and found out he had Attention Deficit Hyperactivity Disorder (ADHD)

One in ten children lives with ADHD. Children diagnosed with the condition are more likely to experience depression, bipolar disorder and anxiety. No one knows exactly what causes this leading disorder but experts believe that it has both genetic and environmental influences.

Two recent research reviews examined whether or not diet can help treat ADHD. While both reviews cite compelling research, each acknowledges that more studies are needed to draw conclusions. As I read both of these papers, one word kept popping up in my mind: prevention.

You see, children with ADHD often have low levels of iron, zinc, magnesium and omega-3 fatty acids – the same nutrients needed for proper growth and development. Research also suggests that some children react to artificial colorings and additives in food.

So doesn’t it make sense that diets rich in these nutrients could help prevent ADHD? While the research isn’t able to answer that question, I think it’s worth considering. Let’s take a look…

Omega-3 fatty acids (DHA & EPA)
It’s hard to believe but sixty percent of the brain is composed of fat! Docosahexaenoic acid (DHA), an essential fatty acid found mostly in fish and fish oils, is required in high quantities in the brain and retina. Eicosapentaenoic acid (EPA) also plays a role in the brain working synergistically with DHA.

According to a recent study published in Nutrition Reviews, omega-3 fatty acids hold the most promise for nutritionally treating ADHD and/or learning disabilities. In a recent UK study, children with developmental coordination disorder (5-12 years old) were supplemented with 552 mg of EPA and 168 mg of DHA for 3 months which resulted in improved behavior, increased reading age by 9 months (3 months in the control) and spelling age by almost 7 months (1 month in the control). Before the study these children were a year behind in both reading and spelling.

DHA and EPA are essential in little ones’ diets because their brains are still developing. Unless your child eats fish on a weekly basis, they are falling short on DHA and EPA. Unfortunately, there are no recommendations for DHA in the United States. International health groups, however, do provide recommendations for adults. According to the Omega-3 Institute, if you take these international recommendations and adjust them to the calorie intakes of young children, 2-3 year olds need 145 mg per day of DHA and 4-6 year olds need 200 mg.

So what’s a mom to do? Include fish meals 2-3 times a week including salmon, tuna, halibut, shrimp and trout. And if your little one won’t eat fish consider supplementing with fish oil (I’ll be reviewing some supplements soon). If you are pregnant or breastfeeding, aim for 300mg of DHA per day.

Minerals
Children with ADHD tend to have lower levels of iron, zinc and magnesium than kids without the disorder. In children under 3 years of age, one-third are anemic and 1 in 10 are iron-deficient. If left untreated, iron deficiency can result in poor cognitive development and can adversely affect behavior. Studies show that children with the lowest iron levels experience more severe ADHD symptoms.

To ensure adequate intake of iron, offer children meat and poultry often as well as iron fortified cereals combined with a vitamin C-rich fruit (to increase the absorption by four times!). Check this list for iron sources and add vitamin C-rich foods to plant-based sources of iron.

Zinc, the next mineral on the list, not only helps protect the immune system, it also plays a role in the developing brain. As zinc levels plummet, the symptoms of ADHD increase. One theory is that certain food additives accelerate the excretion of zinc from the body in susceptible individuals. Zinc can be found in meat, poultry, beans, fortified breakfast cereals, yogurt, almonds and cashews.

Magnesium, the last mineral associated with ADHD, is needed for over 300 biochemical reactions in the body. Low magnesium levels impact brain health in a variety of ways such as decreasing blood flow to the brain and lowering energy metabolism. Research suggests that up to 85% of children with ADHD may be deficient in magnesium. Check this list for magnesium sources including nuts, spinach, soy beans and black beans.

Food additives and artificial colorings
Although we’re mostly focusing on nutrition, the effect of artificial colorings and additives deserves attention. According to a 2009 review in the Harvard Medical Health Letter, a small segment of children are susceptible to artificial additives in processed foods.

In fact, the findings of a recent study in Britain resulted in the United Kingdom’s Food Standards Agency request for food manufactures to remove six coloring agents from children’s products.

To keep intake of such food additives low, go easy on candy, colored cereals, soda and fruit drinks.

The final word
Omega-3 fatty acids, iron, zinc and magnesium are essential nutrients for growing kids. And if they happen to prevent ADHD, then that’s a big bonus.

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References
June, 2009 Harvard Medical Health Letter

Sinn N. Nutritional and dietary influences on attention deficit hyperactivity disorder. Nutrition Reviews. 2008; 66(10):558-568.

Richardson AJ, Montgomery P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics. 2005;115(5):1360-1366.