the power of nutrition: children’s health and digestive problems alison peacham course leader...
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The Power of Nutrition: Children’s Health and Digestive Problems
Alison Peacham
Course Leader NTDC, ION
Nutritional Therapist
B Ed (Hons) Dip ION
What will we cover?
Introduction to the ION Children’s Clinic
Overfed and undernourished
Review common digestive problems and the Nutritional Therapy approach
Links between the gut and a number of conditions
Nutritional management
Clinical case
The ION Children’s Clinic
Clinic for the nutritional treatment of children from birth to 18
Diet, lifestyle and supplement advice
Biochemical tests
The approach is based on ‘biochemical individuality’ tailored to age and development to address health imbalances
Assessing the condition
Testing plays a central role in identifying the underlying aetiology of a health condition. Tests commonly used in the Children’s Clinic:
Stool tests for digestive imbalances and parasites
Finger prick blood sample for food intolerances
Urine tests for metabolic imbalances
The National Diet & Nutrition Survey: young people aged 4-18 years
Most common foods (more than 80%) during a 7 day dietary record were white bread, savoury snacks, potato chips, biscuits, boiled, mashed or jacket potatoes & chocolate confectionery
Three quarters of young people drank standard carbonated soft drinks & 45% low calorie versions Food standards Agency 2000
The National Diet & Nutrition Survey: young people aged 4-18 years
Average intake of most minerals in the youngest were above RNI – except zinc
Older groups average intakes of minerals below RNI: zinc in all groups, potassium, magnesium, calcium and iron in older girls
13% of 11-18 year olds had poor vit D status
Those in lower socio-economic groups tended to have lower biochemical status of vitamins such as folate, riboflavin, vit D and iron
Why is this important?
Vital for growth, development, mind and mood
Common gastrointestinal
problems in children
Functional abdominal pain
Functional abdominal pain (FAP) where histopathology is normal
In a prospective cohort study of 237 children, higher rates of anxiety and depression were reported. Gastrointestinal symptoms were assessed weekly. During the course of the research 23% of children were absent from school. (Saps et al., 2009)
GP testing important
A comprehensive digestive stool analysis is recommended
Sensitivities and allergies
“Food allergy is becoming an increasing problem worldwide with an estimated 6 – 8% of children affected at some point in their childhood...Estimated 20% of children adhering to some form of elimination diet” (Noimark & Cox, 2008)
Six Day Diet Diary
What is the child eating regularly?
Some food may be eaten extensively
Simple exclusion diets can be appropriate for young children
Many underlying factors cause reactions to foods e.g. Lack of digestive enzymes, dysbiosis, nutritional insufficiency
Dietary Assessment – provides clues to problem foods
Reactions that are immunologically mediated (allergic IgE reactions)
Non-IgE mediated reactions e.g. food intolerances
Consider Functional Laboratory Testing
Healing options: elimination or rotation diet, glutamine, probiotics, digestive enzymes, liver support
Increased intestinal permeabilityFoods can damage the gut mucosa
Chronic stress, infection with bacteria, yeast or parasites, repeated use of antibiotics can cause ‘leaky gut’
Enzyme production may be negatively affected and food may not be fully digested; puts an extra burden on the liver
Healing options
Functional testing – Intestinal permeability test, may be done in conjunction with CDSA & parasitology
Avoidance of sensitive foods
Digestive enzymes to assist digestion and absorption of food
Zinc for gut repair
Glutamine to repair mucosal lining
Probiotics and prebiotics to increase beneficial bacteria
Management of food allergy: vitamins, fatty acids or probiotics?
Probiotics have been shown to reverse the increased intestinal permeability characteristic of children with food allergy and to enhance specific IgA responses frequently defective in children with food allergy (Laitinenk & Isolauri, 2005)
Constipation
Constipation: The prevalence in children (0-18) is estimated to be between 0.7 and 29.6 per cent (Van den Berg et al.,2006)
Underlying causes include poor diet, lack of physical activity and psychological factors & a family history of constipation (Inan et al.,2007)
Healing options
Consider lactose intolerance, food sensitivity, leaky gut, dysbiosis, parasitic infection
See Nutritional Management
Prune juice is tasty and has a laxative effect. (1/3 cup diluted with 2/3 water)
Magnesium relaxes muscles and promotes peristalsis
Other common GI problems in children
Colic in infants
Nausea and vomiting
Celiac disease / gluten intolerance
Diarrhoea
Ulcerative colitis
Crohn’s disease
IBS
Aim to look at how GI problems are linked to other conditions
Autism
Evidence of impaired gut immunity and gut inflammation
The possibility and probability of a gut-to-brain connection in autism (Reichelt & Knivsberg, 2009)
Support with probiotics
Support SigA production – whey protein powder
Reduce inflammation – Essential fatty acids, antioxidants
Gut link with inflammation
Commensal microbes of the intestine actively induce tolerant responses from the host that coordinate healthy immune responses
Disruption of this dialogue between the host and microbe can lead to the development of autoimmune diseases such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), or Type I diabetes (TID). (Round et al., 2010)
4R model
Remove (e.g. Yeast, bacteria, parasites, foods that result in allergic or intolerant responses)
Replace (e.g. digestive enzymes, hydrochloric acid)
Re-inoculate ( e.g. pre and probiotics. Lactobacillus and bifidobacteria. Saccharomyces boulardii increases Sig A)
Repair (e.g. Glutamine for gut lining, EFAs, zinc)
Strategy for GI problemsNo two children are treated identically but there is
advice common to most children
Keeping processed foods low e.g. Cakes, biscuits, crisps – make every meal count towards nourishing your child
Eating healthy whole foods rich in fibre such as oats and legumes including at least 5 fruit & veg per day
Careful use of fibre
e.g. 1 teaspoon soaked linseeds
Strategy for GI problems
Drinking fluids as dehydration may be a factor in constipation (Arnaud, 2003)
Removal of food allergens
Restore nutrient adequacy – achieving balance of macro and micronutrients
Ideas to help change habits
Lead by example
Reward charts
Gradual introduction of healthy ingredients
Make your own versions e.g. fish fingers
Special cups and plates.
Involve children – selecting foods, cooking foods, growing foods.
Don’t let meals become a battleground
Older children need to understand the benefits.
Case Study
Natalie aged 8 years
Persistent abdominal pain
Medical investigations could find no cause. Blood tests for inflammatory markers and coeliac disease are negative
Case study
RecommendationsComprehensive Digestive Stool Analysis and Parasitology test
Foodscan 113 Food Intolerance Test from York Laboratories
Comprehensive Digestive Stool Analysis
Indicates good digestion and absorption i.e. adequate digestive enzymes
No indication of inflammation or tissue damage
Low levels of beneficial bacteria.Bifidobacterium should be recovered at levels of 4+ so beneficial to supplement probiotics.
Candida albicans 1+ levels (signifies dysbiosis)
Parasite Dientamoeba fragilis at low levelssignificant and requires treatment
York Foodscan IgG food intolerance:
Cows milk (3)
Some reaction to egg white and yeast
Strategy
Improve diet and support digestive system:
Aim to balance diet and macronutrients
Aim for 5 fruit and veg daily.
Natalie is a fussy eater but she thought peas, raw carrot sticks, sweet corn and broccoli may be ok. Introduce a tiny amount initially. The reward chart may help with trying new foods
Strategy
Introduce oily fish such as salmon, mackerel, & sardines (2 – 3 times a week). Essential fats support the gut lining. Fish pies, fish cake and homemade fish fingers can be a good way of disguising fish
1 tsp soaked linseeds ground provide EFAs and are cleansing for the gut. Sprinkle on cereal
Ensure eating when relaxed and food chewed well
Strategy
Avoid dairy products for about 8 weeks– re IgG antibody reaction. Replace with fortified rice, oat, almond or coconut milks. Soya yoghurt. Inclusion of calcium rich foods such as sardines, broccoli, nuts and seeds
Protocol – remove parasite (anti-fungals), remove intolerant foods, add probiotics, support liver function, heal the gut
The power of nutritionMany adults who consult a nutritional therapist have years of health problems to improve
Children tend to respond quickly to improvements in diet and lifestyle
NT gives children the possibility of achieving their potential. It looks at the combined effects of the child’s biochemistry, physiology, psychology and a host of environmental factors
The Institute for Optimum Nutrition
Children’s clinic
Come and visit us at stand 2116
www.ion.ac.uk/clinics.htm
To book an appointment call
020 8614 7822
A specialist clinic and centre of excellence