Susan R. Johnson MD, FAAP, 11/20/2000, revised 2/7/09
There were not many courses dealing with nutrition in medical school or during my pediatric residency. I correctly learned that sailors on prolonged voyages at sea could get scurvy if they didn't have enough vitamin C but I incorrectly learned that we should avoid eating fats and especially fats containing cholesterol.
Since then I have taken it as an important part of my work as a pediatrician to study nutrition and to keep abreast of research about the relationship between diet and health. This is a vast and complex field but there are certain basic guidelines that I share with all the families whom I work with. These recommendations apply both to children and adults.
Reduce or eliminate white sugar and white flour from your diet
Sugar and white flour products are refined carbohydrates that require our own body’s minerals (like zinc), B vitamins, and enzymes to be processed. Because these substances contain little to no minerals, vitamins or enzymes, they continually deplete our body's supplies. Our digestive organs do not function well without a good supply of vitamins, enzymes, and minerals, and therefore our digestion is weakened.
Consuming sugary foods, especially in the absence of proteins and fats, stimulates the pancreas to over-secrete insulin which causes a rapid drop in our blood sugar (hypoglycemia) leading to emotional irritability and temper tantrums in our children. Hypoglycemia also triggers the release of stress hormones which suppress the immune system. There has also been a rise in Type II diabetes among adolescents, and many health professionals are concerned about the role of too much sugar in our children's diet and its relationship to an over-stimulation of the pancreas (caffeine also stimulates insulin release from the pancreas which is why one craves carbohydrates or sweets after drinking a can of diet coke or cup of coffee).
Many nutritionists believe that too much sugar in the diet (in addition to antibiotics which destroy healthy intestinal bacteria) can lead to an overgrowth of Candida (a form of yeast) in the gastrointestinal tract and may lead to the "leaky gut” syndrome. In this condition, the lining of the intestines become inflamed and allows foods to be passed into the blood stream before properly being broken down. The immune system overreacts to these partially digested food particles (often partially digested proteins), and allergies and food sensitivities result. There are also direct toxic effects from the byproducts secreted by the yeast and other “unhealthy” bacteria that thrive in our intestine when we consume too much sugar. (See Leaky Gut article).
Instead of sugar-sweetened fruit drinks and sodas, drink filtered or other good quality water, herbal teas, and 100% fruit juice diluted with tea or mineral water. Avoid full strength fruit juices; They can contain as much sugar (fructose) as a candy bar and can cause a similar reaction.
Avoid artificial sweeteners such as Nutrasweet and aspartame commonly found it diet drinks. These mimic neurotransmitters in the brain and have been associated with neurological symptoms in children.
Also eat foods that contain beneficial intestinal organisms like Bifidobacterium and Lactobacillus. Many of these organisms are like little factories that produce B vitamins and other nutrients the body needs. Foods like home made yoghurt and kefir as well as fermented cabbage and beets contain these organisms(See book called Nourishing Traditions by Sally Fallon for recipes). I recommend that children and adults take a good quality probiotic at bedtime for 4 months, especially if they have taken an antibiotic in the past one or two years. Antibiotics destroy all the beneficial intestinal bacteria and promote the growth of yeast and parasites in the intestine.
Eat whole grains as a dietary staple
Whole grains provide a balance of carbohydrates, protein, fats, minerals and vitamins. Nearly every traditional culture has had one or more of the whole grainswheat, rye, oats, millets, rice, corn, barleyas a primary source of nutrition.
Whole grains can be eaten in the form of bread, pasta, or as a cooked cereal. Some nutritionists, most notably Sally Fallon, author of Nourishing Traditions recommends soaking and fermenting whole grains before cooking them. The outer layer of whole grains contain phytic acid which can combine with calcium, magnesium, copper, iron, and zinc in the intestinal tract and block their absorption.
Fallon believes that a diet high in unfermented whole grains can lead to mineral deficiency and bone loss. When grains are soaked and allowed to ferment, enzymes from lactobacilli and other microorganisms break down and neutralize the phytic acid. Soaking and fermenting also start to break down gluten and other hard to digest proteins found in oats, wheat, rye, and barley. Brown rice and whole millet do not contain gluten and have lower amounts of phytic acid so it is not so crucial to soak them. Many children and adults with the “Leaky Gut Syndrome” have difficulty breaking down the protein gluten and will need to avoid gluten products for 4 to 6 months until their intestinal lining has healed.
Use good quality fats and oils
For many years after medical school I did not eat butter and drank only non-fat milk. Good quality fats and oils are important for our health. Infants and children especially, need fats and their accompanying vitamins and minerals for the myelination of their nervous systems. Myelin is the protective sheath that surrounds and protects nerve fibers.
Research indicates that Omega-3 fatty acids are critical for brain growth and myelination and the health of the immune system and the heart.Pharmaceutical grade fish oil or cod liver oil that has adequate Vitamin D (where the proportion of Vitamin A to Vitamin D is about 1:1) is an excellent source of omega 3 fatty acids like DHA and EPA. I usually recommend 1/2 tsp/day of oil for children 3 to 5 years of age and 1 tsp/day of oil for anyone 6 years of age or older. I often recommend mixing the fish or cod oil in 1 to 2 tablespoons of organic grape juice if the child doesn’t want to take the oil by itself.
Expeller-expressed organic flax seed oil is also rich in an omega 3 fatty acid known as ALA. It can be added to salad dressing or mixed with other uncooked foods. It is important to note that children and adults eating a high sugar/pasta diet are often depleted of the vitamins and minerals that the body uses to convert the ALA omega 3 fatty acid in flax seed oil to the DHA and EPA omega 3 fatty acids that the brain can utilize.
Extra virgin olive oil has a high enzyme content and is rich in antioxidants. It is also good in salads.
Butter (Ghee), coconut oil, and olive oil are best for cooking and baking. Use coconut oil for moderate to high temperature cooking and butter and olive oil for low temperature cooking. Even olive oil and butter can convert to unhealthy trans fats if exposed to high heat. Avoid cooking with other oils, such as corn, sunflower, soybean, safflower, and cottonseed. High heat causes these unsaturated oils to change their form to trans fats and the oils become toxic to our bodies. Diets high in omega 6 fats relative to omega 3 fats promote inflammation in the body.
Organic butter from pasture fed (not soy or cottonseed fed) cows is an excellent fat. Organic butter is rich in the fat soluble vitamins (especially A and D) and contains Activator X (which helps the body absorb and utilize minerals and many trace minerals).
Canola oil now found widely even in natural food stores is also best avoided. Developed from rape seed, its easily becomes rancid, and its omega 3 fatty acids are transformed into more harmful fatty acids (similar to margarine) during processing. There is a concern that consumption of canola oil can actually cause a deficiency of Vitamin E.
Margarine is the worst food substance for our body. This partially hydrogenated fat is thought to block utilization of essential fatty acids and thereby impair our immune system. Consumption of hydrogenated fats is associated with many serious diseases including cancer, atherosclerosis, diabetes, obesity, bone and joint problems, and immune system dysfunction.
Use whole organic, non-pasteurized milk and milk products
I learned during my training in Switzerland that non-organic, ultra-pasteurized, homogenized milk is not a healthy food. Pasteurization destroys most of the natural enzymes found in milk. These enzymes help pre-digest the lactose sugar and help in mineral absorption. The heating of the milk in pasteurization also destroys vitamins B-6 and B-12. B-12 is essential to the health of the nervous system and a B-12 deficiency can lead to serious behavioral problems such as irrational rage.
Organic, whole, raw milk from pasture-fed cows is an excellent food. This milk as well as butter, kefir, cheese, yoghurt, sour cream, and quark made from it are good sources of quality fats, vitamins, and minerals. While some children are allergic to milk they sometimes can tolerate kefir, yoghurt, butter and cream. The fermentation process used to make home made yogurt and kefir will convert the double sugar of lactose to the single sugar, galactose, which is much easier to digest. The fermentation process also breaks down the milk protein so it is more easily digested.
Use biodynamic or organic vegetables and fruits
Biodynamic agriculture is a type of organic farming that was developed by Rudolf Steiner, the founder of Waldorf Education. Biodynamic foods like other organic products contain higher amounts of enzymes, vitamins, and minerals. Commercially farmed soils have become depleted of minerals and cannot produce nutritious foods. Some commercial oranges may not contain any vitamin C.
A healthful diet includes large amounts of fresh vegetables and fruits, both cooked and raw. Fermented vegetables, like sauerkraut, pickled (not with vinegar) carrots, cucumbers, and beets, are good sources of enzymes. Grapes, figs, avocados, dates, bananas, papayas, pineapples, kiwis and mangoes are fruits with a high enzyme content. Cooking vegetables with lemon juice helps to preserve their vitamin content.
I recommend a delicious veggie juice made by juicing 5 large sticks of organic carrots, 5 stalks of organic celery, 1 large green organic cucumber, 1 to 2 organic red beets, and 1 to 2 organic red apples. This juice provides lots of enzymes, minerals and vitamins. I then save the pulp from the juicer and put it in the refrigerator. Later that day or the next I mix in a blender the pulp from the juiced vegetables and apples with 1 cup Odwalla green juice or fresh orange juice (this is my exception to the juice rule). This makes a thick smoothie loaded with nutritious fiber that can be eaten with a spoon.
Drink plenty of good quality water
Drink plenty of good quality water between your meals. It is usually recommended to drink one half of your body weight in ounces of water, every day. It is important to drink water between meals since drinking water during a meal will dilute the acid concentration in your stomach and make it harder for your body to breakdown the proteins in your food.
Create a positive atmosphere around meal times
Certain less tangible elements also belong to nutrition. It is important at mealtimes to create a space free of the hurry and tensions of the day. To light a candle at mealtimes and to sing or say a blessing to express thankfulness brings a mood of quiet and reminds us to be grateful of the gift of food about to be shared. Digestion occurs best and nutrition is optimized when our mealtimes are taken in a calm, warm, and loving social atmosphere. When the nervous system is relaxed then digestion is enhanced.
A Healthful Breakfast
Most ready-to-eat boxed breakfast cereals are made by the extrusion process in which the flakes are formed under high temperature and pressure. This destroys many valuable nutrients and makes certain proteins toxic. Some breakfast cereal makers are using genetically modified grains to make their products. In the making of granola, the grains are cooked by dry heat and are therefore not easily digestible.
Here is an easy recipe for oatmeal.
You will need some whey for the recipe. Scoop out a couple of tablespoons of yogurt from a container of organic yogurt made from whole milk. In a few hours a clear liquid will have filled in the scooped out area. This is whey.
In the evening heat 2 cups of water in a saucepan until it is luke warm. Add half a cup of organic oats (like steel cut oatmeal) as well as one to two tablespoons of whey. Lemon juice can substitute for the whey. Cover the pan and let soak overnight. In the morning, add another cup of water to the oats, plus 1/2 teaspoon of salt, bring to a boil, reduce the heat, and simmer for three to five minutes. One to two tablespoons of ground flax seeds can be stirred in along with coconut flakes, almonds (that have been soaked and slow-roasted) and biodynamic or organic raisins.
The oatmeal is creamy and tastes great plain or with applesauce, butter, maple syrup, or raw honey.
To make oatmeal pancakes combine every cup of cooked oatmeal with one raw egg. Mix together and then spoon onto a flat gridle or frying pan that has been heated with coconut oil. Cook on medium heat and flip the pancake until both sides appear done. These pancakes tastes great with maple syrup mixed with some apple sauce. These pancakes can also be refrigerated or frozen and then heated up the next day by putting them in a 350 degree oven for 15 minutes or putting the frozen pancakes in a toaster.
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© Susan R. Johnson, M.D., F.A.A.P.