I think there is a lot of confusion on what a dietitian/nutritionist can do. You might think all we do is give out meal plans and tell you to stop eating certain foods and therefore make your life miserable. We have a bad reputation of being strict and boring professionals. And with all the information […]
Picky eating and other feeding problems are common in children. It is estimated that 20-50% of normally developing children, and 70-89% of children with developmental disabilities, are reported to have some type of feeding problem. A child who is described as a picky eater is usually selective about many areas of their food, such as color, texture, smell, presentation (is the food touching other foods on the plate). They may not have a lot of variety of foods that they are willing to accept but usually there are at least 30 different foods they will eat. They will sometimes agree to try a new food, though often reluctantly and maybe only try it after they have been exposed to the food several times. However, picky eaters usually with still have normal growth and development and it is more of a source of frustration for the family that a serious medical condition.
A child who has a feeding disorder frequently will cry and fall apart when they are introduced to a new food. They may refuse entire categories of foods. The family will describe the meal as being a chore and state that their child would happily miss meal times and doesn’t appear to have an appetite. Children with feeding disorders will frequently have separate meals and in some cases will eat alone and not with the rest of the family. The list of acceptable foods is usually less than 20 different foods and some of the foods that they once found acceptable have just moved to the unacceptable list and are now on the ever growing permanently refused list of foods. Meals are often described as a “battle” and it is difficult for anyone to feed the child, not just the immediate family. Feeding disorders can be a serious problem and can interfere with normal growth and development and may need further evaluation.
Childhood Eating Disorder?
Recently there has been an increasing trend for younger children under aged 10 to exhibit symptoms that look like adult eating disorders such as spitting out food instead of swallowing it, avoiding mealtimes, food hoarding, eating in secret, or fearing specific foods or food groups, often weight loss may occur & there tends to be a downward trending growth curve. These signs are present in spite of the fact that the child does not have any known medical condition that is connected to these behaviors. In this case and depending on the child age it could be a feeding disorder or an eating disorder and further exploration is needed.
When to see a professional
Feeding disorders can be medical or behavioral or a combination of both. Behavioral feeding problems can be related to cultural expectations, family expectations, power struggles, anxiety and a variety of other possible food related issues. Medical reasons can be related to premature birth, a history of feeding tubes or frequent hospitalization, developmental disabilities & swallowing problems. An evaluation by a specialist in pediatric feeding disorders is recommended whatever the reason behind the feeding disorder. The specialist may decide to refer the child to other specialists in pediatric feeding issues, depending on their findings, this may include further evaluation by a Speech Language Pathologist (SLP), an Occupational Therapist (OT) a Registered Dietitian (RD) or a Gastroenterologist or a Psychologist. Depending on the type of feeding disorder the team can decide on a care plan and begin treatment.
What to do if the child is a picky eater but does not have a feeding or eating disorder?
If the child is a picky eater but does not have an eating or feeding disorder there are still things family and caretakers can do.
- Give the child some choices (do you want a banana or an orange? do you want your blue cup of your green cup?)
- Use a plate which has separate compartments so the foods do not touch each other, this may be especially important in the younger child
- Involve the child in the food preparation
- Serve small portions, some children can feel overwhelmed by large servings, especially with unfamiliar foods. It’s always better for them to ask for more than refuse the food entirely.
- Have scheduled meals and snacks, do not skip meals and do not allow grazing or snacking all day. (3 meals and 2 or 3 nutritious snacks per day are recommended).
- Encourage but never force the child to eat. Do not threaten the child (For example, “If you don’t eat your pea’s you can’t have any ice-cream”). Threats will usually just lead to a power struggle and further food refusal.
- End the meal after 30 minutes. If they are hungry there will be a scheduled snack coming up in a few hours where there is an opportunity to provided more nutritious foods.
- When introducing a new food know that often a child may refuse it and may need to be exposed to that food approximately 10 times before it becomes acceptable.
- Don’t allow the child to get most of there calories from beverages. Offer water with meals instead of higher calories beverages. Nutritious beverage can be offered with snacks instead.
- As much as possible make mealtimes stress free (I will be writing more about this in a future blog).
If you want to learn more about picky eaters there are several good books on this topic & a quick Google search will lead you to a list of titles that can provided you with further ideas and information. If you suspect a feeding disorder or an eating disorder contact your child’s doctor or a pediatric feeding disorders specialist for further evaluation.
This is a question I hear quite often in my private practice. There is no one easy answer or any one miracle food, but there are certain foods and nutrients that might make you feel more energized after you have first looked at your overall health picture. If you constantly feel fatigued it would benefit you to see your primary care provider and get a physical and some blood work as well as rule out any of the more common concerns that can lead to fatigue such as
- Thyroid problems
- IBS (inflammatory bowel disease)
- Sleep deprivation
- Drug or alcohol addiction
- Shift work
- Sleep apnea.
There are also some serious illnesses, which while less common can also be related to a chronic state of fatigue such as:
- Chronic heart disease
- Psychiatric illnesses
- Connective tissue diseases
- Neoplastic disease
- Chronic infections (eg, AIDS)
- Endocrine diseases (eg, Addison disease)
- Liver disease
- Renal disease
Once your have ruled these illness and conditions out. It’s time to look at your lifestyle, your activity level & your usual nutritional intake.
Are you starting the day out right with a balanced breakfast?
One that contains both carbohydrate and protein? The Academy of Nutrition and Dietetics recommends eating carbohydrates for energy and protein for endurance. Some quick options include:
- Cereal with fruit and yogurt
- A smoothie made with fruit, and a protein sources such as Greek yoghurt.
- Whole grain toast with peanut butter and fruit
- Hard-boiled egg with whole wheat bread
- Scrambled eggs, toast, and fruit
Are your drinking enough water?
Dehydration is one of the main reasons people can feel exhausted. If you’re not well hydrated, your body will use its resources to maintain your fluid balance not your energy. Make sure you are well hydrated through the day; you may want to pay attention to just how much water you are drinking during the daytime.
Are you using caffeine and simple sugars to stay alert?
While some caffeine can be helpful too much can rebound and cause more fatigue and sleep cycle disturbances. Try switching to ginger tea or green tea, which has less caffeine that coffee. Stop drinking caffeinated drinks 8 to 10 hours before you go to bed. Also if you drink soda try to eliminate it or switch to a mixture of soda water with a splash of juice for flavor. Caffeine withdrawal can lead to headaches so if you currently use a lot of caffeine then gradually wean off to prevent negative side effects.
Are you eating fresh fruits and vegetables every day?
Aim for 5 servings per day and when you need a boost grab some fruit and avoid the highly processed snack foods & fast food. Fruits and vegetables are vitamin & mineral powerhouses and will give you the nutrients you need to stay energized until your next meal. Grab a handful of nuts that are rich in Magnesium (see below) to have with your fruit. Magnesium: sources include Almonds, walnuts and Brazil nuts; this is a mineral important in converting carbohydrates into energy. Other good sources of magnesium include whole grains and dark green vegetables.
Are you getting Omega-3 fatty acids in your diet?
Omega – 3 can reduce inflammation, combat depression and improve mood and memory. Sources include salmon, tuna, walnuts, flax seeds, leafy greens and hemp seeds.
You may wish to consult with a registered dietitian (RD or RDN) who can do a full nutritional assessment & help determine if you need to modify your diet & if you need a nutritional supplement.
Sara Flores, RDN
Registered and Licensed Dietitian Nutritionist
Lets start by just forgetting the word “diet”. Just in case you haven’t already figured this out on your own I’m going to let you into a secret most dietitians have known forever: diets don’t work!
Let me explain, instead of dieting we need to change the way we think about food, eating and nutrition. The problem is that when we hear the word “diet” we think of something that is temporary, we think about what we are NOT going to eat rather than what we will eat. In other words when we hear the word diet we usually think about it in a negative way. All doom and gloom and you just can’t wait for it to be over. This is probably why we think of diets as being something we “need a day off from”or a “cheat” day. In other words, diets are generally something we can’t wait to stop doing.
How can anything that is temporary have long lasting results? It can’t! This means that most diets are illusions; if you are dropping 6 or 10 lbs in a week you are losing water weight not belly fat because our bodies are mostly made up of water; in fact the human body is more than 60 percent water. Blood is 92 percent water, the brain and muscles are 75 percent water, and bones are about 22 percent water. Which is why a human can survive for a month or more without eating food, but only a week or so without drinking water.
Think back to the last time you tried to diet, did someone hand you some instructions with a list of foods NOT to eat for one reason or another & then some vague reference about it being based on “scientific evidence”. (Show me the research and I don’t mean one study that had 10 participants, and was sponsored by the company that is selling the “miracle” diet). Show me the peer reviewed, evidence based, scientific journal articles and a multitude of studies.
So you bought it, don’t feel bad. You were mislead and so were millions of other people, that desperately wanted to believe it to be true. Which is what keeps the diet industrial complex going. Maybe you said ”hey yes I need this book, this diet, this plan, this list of foods never to eat again, I’ll do this, this is going to fix my problem”. But in the back of your mind you are thinking about how long do I have to do this? When can I have a cheat day? Then maybe a week or two into following the diet plan you start to miss some of your favorite foods, well that’s the first red flag, when a diet eliminates most of your favorite foods or is very restricting it’s not going to be sustainable, it may not be based on any scientific evidence, and there’s a very good chance, especially in the case of weight-loss for example, you will initially lose some weight (water) but you will not only gain that weight you also gain some additional emergency fat stores (weight) with each “diet”.
So what is healthy eating? There is no one-way to eat healthily. It really depends on the person and their goals. Do you want to gain weight? Do you want to lose weight? Do you want to build muscle? Do you want more energy? Do you want to try being a vegetarian? Have you been diagnosed with a medical issue which means you must change the way eat and possibly even the way you live your life.
When thinking about food, know that variety is the spice of life. There are thousands of foods available to us and yet we have a tendency to focus on just a few of them. Did you know the average person eats only 30 foods on a regular basis? When was the last time you tried a new vegetable or a new fruit that you never before tasted? There are many. If it hasn’t been in the last couple of weeks then it’s time to explore. Variety is important to prevent nutrition deficiencies.
So while there is no one way of eating, that is good for everyone, there are general guidelines which can work for most people and there just needs to be a little fine tuning to make them work for you.Did you know that 35% of normal dieters become pathological dieters, which is a gateway to an eating disorder? It’s time to ditch the diets and if you’re not convinced yet here are a few things to look for when analyzing the quality of the diet or nutrition advice you are receiving.
Here are a few Big Red Flags:
· The diet is very low in any of the macronutrients (macronutrients: carbohydrates, proteins, fat.)
· The diet requires you to purchase highly processed, usually expensive, foods, drinks or supplements that profit the company or person that is also providing the diet.
· You always feel hungry
· There is a long list of foods you must NOT eat, for no scientific reason, and I am not taking about the obvious things like fast food, but some of natures gifts, fruits and vegetables, such as bananas, potatoes, corn, tomatoes, mangos, pineapples avocados. All of these are their own powerhouses and bring something to the table that our bodies can use.
· There are no solid foods on the “diet”, instead the diet is something you must drink every day, every meal. If we were meant to drink all of our nutrition why would we have teeth & such complex digestive systems.
Some people find it helpful to use a food plan, especially initially when they’re changing the way they eat, though eventually you should eat in a way that supports your body and your nutritional needs without having to overthink it. Food plans, are roadmaps towards making healthy change. They should not be crutches and they should not be difficult to follow. They should make sense, be based on real science not pseudoscience & they should not leave you feeling hungry.
If you feel overwhelmed by food plans & the millions of diet books from all the so called diet gurus, & you still want to make permanent changes in your eating, then consider consulting with a registered dietitian (RD or RDN). This is a licensed and registered health care professional who has studies the science of diet & nutrition for many years and can help you separate the fact from the fiction. And there is lots of fiction! A registered dietitian can help guide you and help you create a food plan that works for you. Remember a food plan is not a diet, it’s just a road map to get you started until you learn your way, and discover what’s right for you.
If you had asked me this question 20 years ago as a somewhat newly minted Dietitian, my answer would have been “No you do not need to take supplements, you can get everything you need from food!” But now, I am not so sure this is true in today’s industrialized international food landscape. Maybe if you are raising and growing your own organic food and eating mostly that home grown food and keeping a close eye on ensuring you are eating a vast and varied diet you may want to consider your supplement options.
Lets be realistic and look at our reality: ask yourself how far did your food have to travel to arrive on your plate? Where did it come from? How was it grown or raised, in what conditions? How long was it in transit? How long has it been in your refrigerator? We seem to live in a culture that values food quantity over food quality and in doing so we are probably destroying much of the nutritional value of the food we eat.
Supplementation is a hot button topic among Registered Dietitians (RD); many of us have strong opinions about supplementation. Generally we are either for or against, few of us sit on the fence. As Dietitians we have been repeating the mantra “food first”. When my patients ask me how they can get more protein, or a certain vitamin or mineral I do not rush to suggest supplements instead I talk about the foods that will provide these nutrients and encourage dietary intervention first. However, as I keep up with the latest evidence based scientific information I keep an open mind about nutrition and supplementation. There is some compelling evidence that certain supplements may be appropriate for certain individuals and this has made me seriously reconsiders my former position on supplements.
So why the hesitation? Well it is because much of the supplement industry is not regulated in the USA, unlike the strict regulation imposed on medications. This means that there is a good chance your over-the-counter supplement either doesn’t contain what it says it contains or worse still has contaminants that maybe unsafe. In fact, there is growing concern that supplements may be the reason for some collegiate & professional athletes failed drug testing due to contaminants in supplements that are not listed on the product label.
When shopping for supplements always err on the side of caution: check the FDA.gov website (or follow on twitter @FDArecall) for recalls, withdrawals & safety alerts. Don’t assume that the clerk behind the counter is a nutrition supplement expert, they most likely do not have the full picture about your medical health, your current medications or even any expertise in nutrition. Their job is to sell supplements. Instead, talk to your healthcare providers, such as your MD, RD and Pharmacist, especially if you are taking prescription medications that may lead to a drug interaction. Also, look for the NSF mark on the supplement label, which means the product has been tested by an independent certification organization. Make an appointment with a Dietitian, and a physician and talk with your pharmacist. Any of these providers may be able to review your current supplements and provided unbiased information and recommendations about the supplements you are currently taking or are considering taking. Keep in mind, if your healthcare provider is selling & profiting from supplements sold in their office they may not be able to be truly unbiased. However, some healthcare providers including dietitians may be able to guide you towards professional pharmaceutical grade supplements, many of which are obtained only with a prescription or with a referral & recommendation of your healthcare provider. These supplements must meet FDA and United States Pharmacopeia (USP) standards. The USP tests products that have been voluntarily submitted to the USP Dietary Supplement Verification Program and have successfully met the program’s strict testing criteria. The program was established by USP to help dietary supplement manufacturers ensure the production of quality products for consumers & provides assurance to consumers of the purity and concentration of each dose.
There is much to review when considering supplementing your diet whether it is for the competitive edge in sports, weight gain, weight loss, injury recovery or cognitive enhancement. Use unbiased resources and your healthcare team to guide you through the supplement maze.
Sara Flores, RD
Everybody seems to be detoxing, but is it safe? There is no short answer to this question and it is surrounded by controversy so I will give you some “food for thought” and some tools for you to decide if it is right for you. There are many variations of detoxing methods and as a Registered Dietitian (RD) I am going to focus on nutritional detox. I recently attended a lecture by Doctor Mullin http://thefoodmd.com/the-inside-tract at the annual FNCE conference 2013 and I came away with some great information.
People decide to detox for many reasons. Such as for weight loss, initiating a new diet plan, to attempt to rid their bodies of toxins or for optimal gastrointestinal health.
So should you do it and what are the potential concerns to nutritional detox?
Chances are your body contains toxins even if you work hard at avoiding them as toxins surround us in our environment. Toxins such as heavy metals have been found in water supplies and in lead paint for example; BPA is found in credit card receipts and numerous other items. In fact, according to Doctor Mullin studies show that the umbilical cord of newborn babies contains at least 200 toxins.
The reality is we cannot complete detoxify our bodies. The most common toxins that seem to affect the human body include pesticides, PCB, Heavy metals & BPA. In fact BPA is so widely distributed it’s very difficult to avoid. The problem with toxins is they have been linked to disease, for instance garden pesticides have been linked to leukemia.
Toxins are stored in fat and as we attempt to break down body fat we are disrupting the toxins, but they may not necessarily leave the body. In the worst-case scenarios we can make things worse when breaking down body fat if we do not also consume adequate water and fiber to help move the toxins out of the body. Fiber also helps cultivate healthy (good) gut bacteria.
The detox rituals that concern me the most are those that involve prolonged juicing, which generally lack fiber, is high in fructose (a sugar) and doesn’t contain enough protein. Juicing can also lead to an electrolyte imbalance, which can be quite dangerous. Another type of detox is colon or colonic detoxing, such as hydrotherapy, which can be outright dangerous; it has been linked to perforation of the colon, infection, dehydration & even kidney failure, which can lead to death. All of these have been identified and written about in the medical literature.
So what do I recommended if you want to detox safely, lets focus on what you should eat and drink to “detox” here are some much safer and effective ways:
During your Detox:
- Drink green tea
- Give up highly processed foods
- Drink lots of water and not out of a plastic bottle, or at least make sure it is BPA free
- Use much less plastic
- Don’t microwave in plastic use glass for storing food
- Reduce or better still eliminate your alcohol and caffeine intake
- Eat organic foods to avoid pesticides or at a minimum wash and clean your fruits and vegetable
- Check what kind of cleaning products you are using? Do they contain known toxins?
- Eat more cruciferous vegetables, (Cauliflower, broccoli, brussel sprouts etc.) Which have been linked to inhibiting tumors
- Eat foods in season and buy them locally from organic farmers
- Shop clean and avoid the dirty dozen list of fruits and vegetables http://www.organic.org/articles/showarticle/article-214
- Eat foods rich in phytochemicals/phytonutrients: brightly colored fruits and vegetables (yellow, orange, red, green, white, blue, purple), whole grains/cereals, and beans containing phytochemicals may decrease the risk of developing certain cancers as well as diabetes, hypertension, and heart disease.
- Try going Vegan, at least during your Detox
For a complete list of phytochemicals and further details visit:
Be safe get your nutrition information from a credible source such as a Registered Dietitian or a gastroenterologist.
- Remember if it sounds too good to be true it probably is!
This is an interesting Blog about Emotional Eating written by another Dietitian that I thought would be good to re-blog here. Here are the nuts and bolts of emotional eating.
Most of us who numb out with food experience an aftermath of guilt, shame, and self-loathing. Sometimes the first awareness we have are negative thoughts associated with an emotional eating binge. Although awareness of these thoughts is important or rather, imperative, this type of thinking is neither kind nor gentle. Negative thoughts, and feeling terrible, are helpful in one way however, they alert us that something is profoundly wrong with our relationship to food.
Our relationship to food mirrors our relationship to ourselves. Maybe we are aware that we use food to numb out. I work with many women who know they have a problem with emotional eating but have no idea how to break the cycle.
The emotional eating cycle consists of four parts:
- The Trigger (causing uncomfortable emotions).
- Eating (mindlessly).
- Remorse, guilt, self-loathing.
- Eating more.
This cycle can perpetuate itself endlessly.
If you’re like me you know it’s…
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